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ABSTRACT Objective: To assess the impact of different vertical positions on lung aeration in patients receiving invasive mechanical ventilation. Methods: An open-label randomized crossover clinical trial was conducted between January and July 2020. Adults receiving invasive mechanical ventilation for > 24 hours and < 7 days with hemodynamic, respiratory and neurological stability were randomly assigned at a 1:1 ratio to the sitting position followed by passive orthostasis condition or the passive orthostasis followed by the sitting position condition. The primary outcome was lung aeration assessed using the lung ultrasound score (score ranges from 0 [better] to 36 [worse]). Results: A total of 186 subjects were screened; of these subjects, 19 were enrolled (57.8% male; mean age, 73.2 years). All participants were assigned to receive at least one verticalization protocol. Passive orthostasis resulted in mean lung ultrasound scores that did not differ significantly from the sitting position (11.0 versus 13.7; mean difference, -2.7; [95%CI -6.1 to 0.71; p = 0.11). Adverse events occurred in three subjects in the passive orthostasis group and in one in the sitting position group (p = 0.99). Conclusion: This analysis did not find significant differences in lung aeration between the sitting and passive orthostasis groups. A randomized crossover clinical trial assessing the impact of vertical positioning on lung aeration in patients receiving invasive mechanical ventilation is feasible. Unfortunately, the study was interrupted due to the need to treat COVID-19 patients. ClinicalTrials.gov registry: NCT04176445

RESUMO Objetivo: Avaliar o impacto de diferentes posicionamentos verticais na aeração pulmonar em pacientes em ventilação mecânica invasiva. Métodos: Trata-se de ensaio clínico aberto, randomizado e transversal, realizado entre janeiro e julho de 2020. Adultos em ventilação mecânica invasiva por mais de 24 horas e menos de 7 dias com estabilidade hemodinâmica, respiratória e neurológica foram distribuídos aleatoriamente em uma proporção de 1:1 à postura sentada seguida da condição de ortostatismo passivo ou o ortostatismo passivo seguido de postura sentada. O desfecho primário foi a aeração pulmonar avaliada pelo lung ultrasound score. O escore varia de zero (melhor) a 36 (pior). Resultados: Foram selecionados 186 indivíduos; destes, 19 foram incluídos (57,8% do sexo masculino; média idade de 73,2 anos). Todos os participantes foram selecionados para receber pelo menos um protocolo de verticalização. O ortostatismo passivo resultou em escores médios de aeração pulmonar por ultrassonografia que não diferiram significativamente da postura sentada (11,0 versus 13,7; diferença média, -2,7; IC95% -6,1 a 0,71; p = 0,11). Ocorreram eventos adversos em três indivíduos no grupo ortostatismo passivo e em um no grupo postura sentada (p = 0,99). Conclusão: Esta análise não encontrou diferenças significativas na aeração pulmonar entre os grupos ortostatismo passivo e postura sentada. É factível conduzir um estudo clínico transversal randomizado para avaliar o impacto do posicionamento vertical na aeração pulmonar em pacientes em ventilação mecânica invasiva. Infelizmente, o estudo foi interrompido devido à necessidade de tratar pacientes com COVID-19. Registro ClinicalTrials.gov: NCT04176445

https://doi.org/10.5935/2965-2774.20230069-en

Pre-exercise meal on oxidation of energy substrates during maximal exercise test in non-trained individuals
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Silva, Lucas Ribeiro da

; Stefani, Giuseppe Potrick

; Dorneles, Gilson Pires

; Marcadenti, Aline

; Lago, Pedro Dal

Archives of Endocrinology and Metabolism

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2023, Volume 67 N. 5 elocation e000618

Abstract: En | Text: En | PDF: En

ABSTRACT Objective: This study aimed to compare the influence of a high carbohydrate meal versus high-fat meal on the oxidation of substrates during an exercise incremental test. Materials and methods: Ten untrained male subjects underwent two days of the protocol. Randomly, they received a high carbohydrate meal or a high-fat meal, receiving the other one in the next protocol. On both days, they performed an incremental treadmill test, with heart rate and maximal oxygen consumption to estimate the oxidation of substrates. Results: The high-fat meal showed an increase in the absolute amount of oxidized fat along with the incremental test (P < 0.05; effect size = 0.9528), and a reduction in the respiratory exchange ratio at low intensities (P < 0.05; effect size = 0.7765). Conclusions: The meals presented no difference when compared to maximum oxidation point of substrates, the oxidation rate of substrates over time, and heart rate. A pre-test high-fat meal in untrained individuals was shown to be a modulating factor of total oxidized fats throughout the exercise, although it did not exert a significant effect on the rate of this oxidation over time.

https://doi.org/10.20945/2359-3997000000618

Normative values and reference equation for the six-minute step test to evaluate functional exercise capacity: a multicenter study
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Albuquerque, Vanessa Salles

; Corso, Simone Dal

; Amaral, Daniel Pereira do

; Oliveira, Túlio Medina Dutra de

; Souza, Gerson Fonseca

; Souza, Rachel Naara Silva de

; Nogueira, Ana Karolyn Menezes

; Lago, Pedro Dal

; Dadalt, Maria Luísa Rocha

; Correa, Isadora Faraco

; Cipriano, Graziella França Bernardelli

; Silva, Fabíola Maria Ferreira

; Britto, Raquel Rodrigues

; José, Anderson

; Malaguti, Carla

Jornal Brasileiro de Pneumologia

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2022, Volume 48 N. 4 elocation e20210511

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: Estabelecer valores normativos e uma equação de referência para o número de degraus subidos no teste do degrau de seis minutos (TD6) em adultos saudáveis, bem como avaliar a confiabilidade do teste e da equação. Métodos: Estudo transversal multicêntrico com 468 voluntários saudáveis (faixa etária: 18-79 anos) recrutados na comunidade geral em seis laboratórios de pesquisa em diferentes regiões do Brasil, um país de dimensões continentais. O TD6 foi realizado duas vezes (com 30 min de intervalo entre uma e outra), e foram avaliadas variáveis clínicas, demográficas e funcionais. Uma amostra independente composta por 24 voluntários foi avaliada para testar a equação de referência a posteriori. Resultados: O número de degraus subidos apresentou excelente confiabilidade teste-reteste [coeficiente de correlação intraclasse = 0,96 (IC95%: 0,95-0,97)], e a média de degraus subidos foi de 175 ± 45, sendo 14% maior no sexo masculino. O melhor desempenho no teste correlacionou-se com as seguintes variáveis: idade (r = −0,60), sexo (r = 0,28), peso (r = 0,13), estatura (r = 0,41), IMC (r = −0,22), circunferência da cintura (r = −0,22), circunferência da coxa (r = 0,15), CVF (r = 0,54) e nível de atividade física (r = 0,17; p < 0,05 para todos). Na análise de regressão, idade, sexo, estatura e peso explicaram 42% da variabilidade do TD6. Foram estabelecidos valores normativos para o TD6 de acordo com a idade e o sexo. Não houve diferença entre os valores do TD6 na amostra independente e os valores previstos (157 ± 29 vs. 161 ± 25 degraus subidos; p = 0,47; 97% dos valores previstos). Conclusões: Os valores normativos e a equação de referência para o TD6 neste estudo parecem adequados para predizer com precisão o desempenho físico funcional em adultos no Brasil.

ABSTRACT Objective: To establish normative values and a reference equation for the number of steps climbed during the six-minute step test (6MST) in healthy adults, and to assess the reliability of the test and of the equation. Methods: This was a multicenter cross-sectional study involving 468 healthy volunteers (age range: 18-79 years) recruited from the general community in six research laboratories across different regions of Brazil, which is a country with continental dimensions. The 6MST was performed twice (30-min interval), and clinical, demographic, and functional variables were evaluated. An independent sample of 24 volunteers was evaluated to test the reference equation a posteriori. Results: The number of steps had excellent test-retest reliability (intraclass correlation coefficient = 0.96 [95%CI: 0.95-0.97]), and the mean number of steps was 175 ± 45, the number being 14% greater in males than in females. The best performance on the test was correlated with age (r = −0.60), sex (r = 0.28), weight (r = 0.13), height (r = 0.41), BMI (r = −0.22), waist circumference (r = −0.22), thigh circumference (r = 0.15), FVC (r = 0.54), and physical activity level (r = 0.17; p < 0.05 for all). In the regression analysis, age, sex, height, and weight explained 42% of the variability of the 6MST. Normative values were established for the 6MST according to age and sex. There was no difference between the 6MST values from the independent sample and its predicted values (157 ± 29 steps vs. 161 ± 25 steps; p = 0.47; 97% of predicted values). Conclusions: The normative values and the reference equation for the 6MST in this study seem adequate to accurately predict the physical functional performance in adults in Brazil.

https://doi.org/10.36416/1806-3756/e20210511

Continuous Aerobic Training and High Intensity Interval Training Increase Exercise Tolerance in Heart Failure Patients: A Retrospective Study
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Busin, Diego

; Lehnen, Alexandre M.

; Tairova, Olga S.

; Comparsi, Eduardo P.

; Carneiro, Daniela

; Potter, Micael

; Deresz, Luís F.

; Lago, Pedro Dal

; Nunes, Ramiro B.

International Journal of Cardiovascular Sciences

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oct 2021, Volume 34 N. 5 Pages 508 - 514

Abstract: En | Text: En | PDF: En

Abstract Background: Conventional aerobic training is the first choice in cardiac rehabilitation for patients with chronic heart failure (CHF). However, high-intensity interval training (HIIT) may be an alternative, although it has little evidence. Objectives: To evaluate the effect of continuous aerobic training (CAT) or HIIT on exercise tolerance in CHF patients. Methods: Retrospective study with 30 patients, of both genders, members of a 10-week CAT or HIIT program. The control group (CON) consisted of patients who did not participate voluntarily in the program. Peak oxygen uptake (VO2peak), thresholds (LV1 and LV2), and ventilatory efficiency in the production of dioxide (VE/VCO2 slope), oxygen uptake efficiency (OUES), and VO2 recovery kinetics were analyzed. A two-way or repeated measures ANOVA was used, followed by Fisher's post-hoc test (p<0.05). Results: After 10 weeks of training, the CAT group increased the treadmill speed at LV1 (p=0.040), while the HIIT increased both the speed (p=0.030) and incline of the treadmill (p<0.001) for VO2peak and LV2, as well as the total time of the cardiopulmonary test. The VE/VCO2 slope was lower than that predicted for CAT (p=0.003) and HIIT (p=0.008). There was no change in VO2peak, recovery of heart rate (HR), and VO2, VE/VCO2, and OUES in both groups. Conclusions: After 10 weeks, both CAT and HIIT increased the tolerance to physical exercise. However, HIIT showed improvement in more parameters, differently from CAT.

https://doi.org/10.36660/ijcs.20200124 167 downloads

Pós-graduação stricto sensu em Fisioterapia no Brasil: cenário atual
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Padula, Rosimeire Simprini

; Lago, Pedro Dal

Fisioterapia e Pesquisa

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oct 2021, Volume 28 N. 4 Pages 367 - 368

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

https://doi.org/10.1590/1809-2950/00000028042021

O Teste de Caminhada de 6 Minutos prevê a melhora física em longo prazo de sobreviventes à unidade de terapia intensiva: um estudo de coorte prospectiva
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Rosa, Regis Goulart

; Dietrich, Camila

; Valle, Enio Luiz Tschiedel do

; Souza, Denise

; Tagliari, Luciana

; Mattioni, Mariana

; Tonietto, Túlio Frederico

; Rosa, Rosa da

; Barbosa, Mirceli Goulart

; Lovatel, Gisele Agustini

; Lago, Pedro Dal

; Oliveira, Eubrando Silvestre

; Sganzerla, Daniel

; Andrade, Juliana M. S.

; Berto, Paula

; Cardoso, Paulo Ricardo

; Sanchez, Evelin Carneiro

; Falavigna, Maicon

; Maccari, Juçara G.

; Rech, Gabriela

; Robinson, Caroline

; Schneider, Daniel

; Leon, Patrícia de

; Biason, Lívia

; Teixeira, Cassiano

Revista Brasileira de Terapia Intensiva

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sep 2021, Volume 33 N. 3 Pages 374 - 383

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: Avaliar a capacidade do Teste de Caminhada de 6 Minutos para predizer a melhora do estado funcional físico em longo prazo de pacientes sobreviventes à unidade de terapia intensiva. Métodos: Foram avaliados, de forma prospectiva, entre fevereiro de 2017 e agosto de 2018, em um ambulatório pós-unidade de terapia intensiva, 32 sobreviventes à unidade de terapia intensiva. Foram inscritos consecutivamente os pacientes com permanência na unidade de terapia intensiva acima de 72 horas (para admissões emergenciais) ou acima de 120 horas (para admissões eletivas) que compareceram ao ambulatório pós-unidade de terapia intensiva 4 meses após receberem alta da unidade de terapia intensiva. A associação entre a distância percorrida no Teste de Caminhada de 6 Minutos realizado na avaliação inicial e a evolução do estado funcional físico foi avaliada durante 8 meses, com utilização do Índice de Barthel. Resultados: A distância média percorrida no Teste de Caminhada de 6 Minutos foi significantemente mais baixa nos sobreviventes à unidade de terapia intensiva do que na população geral (405m versus 557m; p < 0,001). A idade (β = -4,0; p < 0,001) e a fraqueza muscular (β = -99,7; p = 0,02) se associaram com a distância percorrida no Teste de Caminhada de 6 Minutos. A distância percorrida no Teste de Caminhada de 6 Minutos se associou com melhora do estado funcional físico no período de 8 meses de acompanhamento desses pacientes (razão de chance para cada 10m: 1,07; IC95% 1,01 - 1,16; p = 0,03). A área sob a curva Característica de Operação do Receptor para predição da melhora funcional física pelo Teste de Caminhada de 6 Minutos foi de 0,72 (IC95% 0,53 - 0,88). Conclusão: O Teste de Caminhada de 6 Minutos, realizado 4 meses após a alta da unidade de terapia intensiva, predisse com precisão moderada a melhora do estado funcional físico de sobreviventes à unidade de terapia intensiva.

ABSTRACT Objective: To evaluate the ability of the 6-Minute Walk Test to predict long-term physical functional status improvement among intensive care unit survivors. Methods: Thirty-two intensive care unit survivors were prospectively evaluated from February 2017 to August 2018 in a post-intensive care unit outpatient clinic in Brazil. Individuals with intensive care unit stays > 72 hours (emergency admissions) or > 120 hours (elective admissions) attending the post-intensive care unit clinic four months after intensive care unit discharge were consecutively enrolled. The association between the 6-Minute Walk Test distance at baseline and physical functional status was assessed over 8 months using the Barthel Index. Results: The mean 6-Minute Walk Test distance was significantly lower in intensive care unit survivors than in the general population (405m versus 557m; p < 0.001). Age (β = -4.0; p < 0.001) and muscle weakness (β = -99.7; p = 0.02) were associated with the 6-Minute Walk Test distance. A 6-Minute Walk Test distance was associated with improvement in physical functional status over the 8-month follow-up (odds ratio for each 10m of 1.07; 95%CI 1.01 - 1.16; p = 0.03). The area under the Receiver Operating Characteristic curve for the 6-Minute Walk Test prediction of physical functional status improvement was 0.72 (95%CI 0.53 - 0.88). Conclusion: The 6-Minute Walk Test performed 4 months after intensive care unit discharge predicted long-term physical functional status among intensive care unit survivors with moderate accuracy.

https://doi.org/10.5935/0103-507x.20210056 132 downloads

Quantification of DNA Damage in Different Tissues in Rats with Heart Failure
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Stefani, Giuseppe Potrick

; Nunes, Ramiro Barcos

; Rossato, Douglas Dalcin

; Hentschke, Vitor Scotta

; Domenico, Marlise Di

; Lago, Pedro Dal

; Rhoden, Cláudia Ramos

Arquivos Brasileiros de Cardiologia

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feb 2020, Volume 114 N. 2 Pages 234 - 242

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Fundamento: A insuficiência cardíaca crônica (ICC) é uma síndrome complexa que compreende alterações estruturais e funcionais no coração, mantendo demanda sanguínea adequada a todos os tecidos. Poucas investigações procuraram avaliar o dano oxidativo ao DNA na ICC. Objetivo: Quantificar o dano ao DNA utilizando o ensaio cometa no ventrículo esquerdo (VE), pulmões, diafragma, gastrocnêmio e sóleo em ratos com ICC. Métodos: Doze ratos Wistar machos (300 a 330 g) foram selecionados para o estudo: placebo (n = 6) e ICC (n = 6). Os animais foram submetidos a infarto do miocárdio através de ligadura da artéria coronária esquerda. Após seis semanas, os animais foram sacrificados. Foi realizada uma suspensão celular dos tecidos. O ensaio cometa foi realizado para avaliar as quebras de fita simples e dupla no DNA. Nível de significância (p) < 0,05. Resultados: O grupo ICC apresentou maiores valores de pressão diastólica final do ventrículo esquerdo (PDFVE), congestão pulmonar, hipertrofia cardíaca e menores valores de derivados máximos positivos e negativos da pressão do VE, pressão sistólica do VE (p < 0,05). O grupo ICC apresentou maior dano ao DNA (% de DNA da cauda, momento da cauda e momento da cauda de Olive) em comparação ao placebo (p < 0,001). O tecido com maior dano foi o sóleo, comparado ao VE e ao gastrocnêmio no grupo ICC (p < 0,05). Conclusão: Nossos resultados indicam que a ICC afeta todos os tecidos, de maneira central e periférica, sendo mais afetada no músculo esquelético (sóleo) e está positivamente correlacionada com a disfunção do VE.

Abstract Background: Chronic heart failure (CHF) is a complex syndrome which comprises structural and functional alterations in the heart in maintaining the adequate blood demand to all tissues. Few investigations sought to evaluate oxidative DNA damage in CHF. Objective: To quantify the DNA damage using the comet assay in left ventricle (LV), lungs, diaphragm, gastrocnemius and soleus in rats with CHF. Methods: Twelve male Wistar rats (300 to 330 g) were selected for the study: Sham (n = 6) and CHF (n = 6). The animals underwent myocardial infarction by the ligation of the left coronary artery. After six weeks, the animals were euthanized. It was performed a cell suspension of the tissues. The comet assay was performed to evaluate single and double strand breaks in DNA. Significance level (p) considered < 0.05. Results: The CHF group showed higher values of left ventricle end-diastolic pressure (LVEDP), pulmonary congestion, cardiac hypertrophy and lower values of maximal positive and negative derivatives of LV pressure, LV systolic pressure (p < 0.05). CHF group showed higher DNA damage (% tail DNA, tail moment and Olive tail moment) compared to Sham (p < 0.001). The tissue with the highest damage was the soleus, compared to LV and gastrocnemius in CHF group (p < 0.05). Conclusion: Our results indicates that the CHF affects all tissues, both centrally and peripherically, being more affected in skeletal muscle (soleus) and is positively correlated with LV dysfunction.

https://doi.org/10.36660/abc.20180198 1297 downloads

Does pulmonary rehabilitation decrease plasma myostatin levels in patients with COPD?
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Araujo, Cintia Laura Pereira de

; Silva, Ivy Reichert Vital da

; Lago, Pedro Dal

Jornal Brasileiro de Pneumologia

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2020, Volume 46 N. 6 elocation e20200043

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.36416/1806-3756/e20200043 352 downloads

Consumo alimentar e risco cardiovascularem pessoas vivendo com HIV/AIDS
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Deresz, Luís Fernando

; Brito, Carina de

; Schneider, Cláudia Dornelles

; Rabito, Estela Iraci

; Ikeda, Maria Letícia Rodrigues

; Lago, Pedro Dal

Ciência & Saúde Coletiva

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aug 2018, Volume 23 N. 8 Pages 2533 - 2542

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo O presente estudo analisou o consumo alimentar e a presença de fatores de risco cardiovasculares em pessoas vivendo com HIV/AIDS (PVHA) em uso regular de antirretrovirais. O consumo alimentar foi avaliado por meio de questionário de frequência alimentar anual, dividido em alimentos protetores e não protetores para doença cardiovascular (DCV). Os dados foram calculados pelo Teste t de Student para amostras independentes, pelo Teste U de Mann-Whitney e pelo teste exato de Fischer, considerando significativo p < 0,05. A amostra consistiu de 45 PVHA (60% do sexo feminino). O consumo de alimentos não protetores para o risco cardiovascular foi maior do que o de alimentos protetores nos homens (3,91 ± 0,26 vs. 2,79 ± 0,32 p = 0,01) e nas mulheres (3,40 ± 0,23 vs. 2,60 ± 0,29 p = 0,04). A prevalência de síndrome metabólica foi 33,3% nos homens e 37% nas mulheres. Os homens apresentaram hipertrigliceridemia (50%) e baixas concentrações de HDL-c (44%), enquanto que as mulheres apresentaram hipertrigliceridemia (46%), hipercolesterolemia (66,7%, p < 0,02 vs. homens) e obesidade central (54%, p < 0,05 vs. homens). Os resultados deste estudo indicam a presença de padrão de consumo alimentar inadequado e elevada prevalência de fatores de risco relacionados às DCV nos indivíduos avaliados.

Abstract This cross-sectional study evaluated the food intake patterns related to cardiovascular risk disease among people living with HIV/AIDS (PLWHA) with viral suppression and receiving highly active antiretroviral therapy (HAART). Food intake was obtained by the annual food frequency questionnaire, separated into two groups, healthy and unhealthy food related intake and cardiovascular disease. Data were analyzed using Student’s t Test for independent samples or the Mann-Whitney U Test and Fisher’s exact test, with a significance level of p < 0.05. The sample consisted of 45 individuals with HIV/AIDS (60% female). The intake of unhealthy foods for cardiovascular risk was greater compared to the intake of healthy foods, both in men (3.91 ± 0.26 vs. 2.79 ± 0.32 p = 0.01) and women (3.40 ± 0.23 vs. 2.60 ± 0.29 p = 0.04). Metabolic syndrome prevalence was 33.3% in men and 37% in women. Men presented hypertriglyceridemia (50%) and low HDL (44%) and women presented central obesity (54%, p = 0.05 vs. men) hypercholesterolemia (66.7% p = 0.02 vs. men) and hypertriglyceridemia (46%). Study results indicate the presence of unhealthy food intake patterns and a high prevalence of cardiovascular risk factors in the evaluated subjects.

https://doi.org/10.1590/1413-81232018238.20542016 2548 downloads

10.

Consumo alimentar e risco cardiovascularem pessoas vivendo com HIV/AIDS
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Deresz, Luís Fernando

; Brito, Carina de

; Schneider, Cláudia Dornelles

; Rabito, Estela Iraci

; Ikeda, Maria Letícia Rodrigues

; Lago, Pedro Dal

Ciência & Saúde Coletiva

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2018, Volume 23 N. 8 Pages 2533 - 2542

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.1590/1413-81232018238.20542016 17 downloads

11.

Respiratory Muscle Training Improves Diaphragm Citrate Synthase Activity and Hemodynamic Function in Rats with Heart Failure
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Jaenisch, Rodrigo Boemo

; Bertagnolli, Mariane

; Borghi-Silva, Audrey

; Arena, Ross

; Lago, Pedro Dal

Brazilian Journal of Cardiovascular Surgery

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apr 2017, Volume 32 N. 2 Pages 104 - 110

Abstract: En | Text: En | PDF: En

Abstract INTRODUCTION: Enhanced respiratory muscle strength in patients with heart failure positively alters the clinical trajectory of heart failure. In an experimental model, respiratory muscle training in rats with heart failure has been shown to improve cardiopulmonary function through mechanisms yet to be entirely elucidated. OBJECTIVE: The present report aimed to evaluate the respiratory muscle training effects in diaphragm citrate synthase activity and hemodynamic function in rats with heart failure. METHODS: Wistar rats were divided into four experimental groups: sedentary sham (Sed-Sham, n=8), trained sham (RMT-Sham, n=8), sedentary heart failure (Sed-HF, n=7) and trained heart failure (RMT-HF, n=7). The animals were submitted to a RMT protocol performed 30 minutes a day, 5 days/week, for 6 weeks. RESULTS: In rats with heart failure, respiratory muscle training decreased pulmonary congestion and right ventricular hypertrophy. Deleterious alterations in left ventricular pressures, as well as left ventricular contractility and relaxation, were assuaged by respiratory muscle training in heart failure rats. Citrate synthase activity, which was significantly reduced in heart failure rats, was preserved by respiratory muscle training. Additionally, a negative correlation was found between citrate synthase and left ventricular end diastolic pressure and positive correlation was found between citrate synthase and left ventricular systolic pressure. CONCLUSION: Respiratory muscle training produces beneficial adaptations in the diaphragmatic musculature, which is linked to improvements in left ventricular hemodynamics and blood pressure in heart failure rats. The RMT-induced improvements in cardiac architecture and the oxidative capacity of the diaphragm may improve the clinical trajectory of patients with heart failure.

https://doi.org/10.21470/1678-9741-2017-0002 1245 downloads

12.

Chronic heart failure modifies respiratory mechanics in rats: a randomized controlled trial
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Pacheco, Deise M.

; Silveira, Viviane D.

; Thomaz, Alex

; Nunes, Ramiro B.

; Elsner, Viviane R.

; Dal Lago, Pedro

Brazilian Journal of Physical Therapy

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aug 2016, Volume 20 N. 4 Pages 320 - 327

Abstract: En | Text: En | PDF: En

ABSTRACT Objective To analyze respiratory mechanics and hemodynamic alterations in an experimental model of chronic heart failure (CHF) following myocardial infarction. Method Twenty-seven male adult Wistar rats were randomized to CHF group (n=12) or Sham group (n=15). Ten weeks after coronary ligation or sham surgery, the animals were anesthetized and submitted to respiratory mechanics and hemodynamic measurements. Pulmonary edema as well as cardiac remodeling were measured. Results The CHF rats showed pulmonary edema 26% higher than the Sham group. The respiratory system compliance (Crs) and the total lung capacity (TLC) were lower (40% and 27%, respectively) in the CHF rats when compared to the Sham group (P<0.01). There was also an increase in tissue resistance (Gti) and elastance (Hti) (28% and 45%, respectively) in the CHF group. Moreover, left ventricular end-diastolic pressure was higher (32 mmHg vs 4 mmHg, P<0.01), while the left ventricular systolic pressure was lower (118 mmHg vs 130 mmHg, P=0.02) in the CHF group when compared to the control. Pearson’s correlation coefficient showed a negative association between pulmonary edema and Crs (r=–0.70, P=0.0001) and between pulmonary edema and TLC (r=–0.67, P=0.0034). Pulmonary edema correlated positively with Gti (r=0.68, P=0.001) and Hti (r=0.68, P=0.001). Finally, there was a strong positive relationship between pulmonary edema and heart weight (r=0.80, P=0.001). Conclusion Rats with CHF present important changes in hemodynamic and respiratory mechanics, which may be associated with alterations in cardiopulmonary interactions.

https://doi.org/10.1590/bjpt-rbf.2014.0163 1153 downloads

13.

Características clínicas e psicológicas de pacientes asmáticos de um Ambulatório de Pneumologia
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Reppold, Caroline Tozzi

; Antunes, Aline Dal Pozzo

; Corrêa, Luciano Muller

; Zanon, Cristian

; Dal Lago, Pedro

Psico-USF

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aug 2014, Volume 19 N. 2 Pages 199 - 208

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

A asma é uma doença crônica e intervenções psicológicas podem melhorar seu manejo. Este estudo objetiva correlacionar características clínicas e psicológicas dos asmáticos. Foram avaliados vinte e quatro adultos asmáticos em Ambulatório de Pneumologia, sendo administrados questionários de controle e qualidade de vida em asma, escalas de Otimismo/Pessimismo, Satisfação de Vida, Esperança Disposicional e Esperança de Staats. Controle da asma apresentou correlação estatisticamente significativa, com escore total (r=-0,69, p<0,01), domínios sintomas (r=-0,64, p<0,01) e emoções (r=-0,53, p<0,01) do Questionário de Qualidade de Vida e com o domínio estímulo ambiental (r=-0,42, p<0,05). Observou-se, também, que a dimensão hope-self (Esperança Staats) obteve correlações estatisticamente significativas com o Questionário de Controle de Asma (r=-0,45, p<0,05). O controle da asma apresentou relação importante com qualidade de vida. Os resultados mostraram que pacientes com maior controle da asma apresentaram maiores escores de esperança, mas não de otimismo.

Asthma is a chronic disease and psychological interventions can improve its management. This study aims to correlate clinical and psychological characteristics of asthmatic patients. Twenty-four patients were evaluated in the Pulmonology Outpatient Clinic of Santa Casa, in Porto Alegre, and were surveyed with asthma control and quality of life questionnaires, Optimism/Pessimism questionnaires, Satisfaction of life, Hope trace and Staats Hope scales. Asthma control demonstrated statistically significant correlation with the total score (r=-0,69, p<0,01), the domain symptoms (r=-0,64, p<0,01) and emotions (r=-0,53, p<0,01) of the Quality of Life Questionnaire and with the ambient domain (r=-0,42, p<0,05). The hope-self dimension (Staats Hope) showed statistically significant correlation with the Asthma Control Questionnaire (r=-0,45, p<0,05). Asthma control has an important relationship with quality of life. The results showed that patients with greater asthma control had higher scores of hope, but not optimism.

El asma es una enfermedad crónica e intervenciones psicológicas pueden mejorar su gestión. Este estudio pretende correlacionar características clínicas y psicológicas de los asmáticos. Se evaluaron veinticuatro asmáticos del Ambulatorio de Neumología de la Santa Casa de Porto Alegre, siendo administrados cuestionarios de control y calidad de vida en el asma, escalas de Optimismo/Pesimismo, Satisfacción con la Vida y Disposición de Esperanza e Esperanza Staats. El control del asma mostró una correlación estadísticamente significativa con la puntuación total (r=-0,69, p<0,01), el dominio síntomas (r=-0,64, p<0,01) y emociones (r=-0,53, p<0,01) del cuestionario de calidad de vida y con el dominio de los estímulos ambientales (r=-0,42, p<0,05). También se observó que la dimensión hope-self (Esperanza Staats) mostró correlación estadísticamente significativa con el Cuestionario de Control del Asma (r=-0,45, p<0,05). El control del asma presentó una relación importante con la calidad de vida. Los resultados mostraron que los pacientes con mayor control del asma tienen mayores puntuaciones en esperanza, pero no de optimismo.

https://doi.org/10.1590/1413-82712014019002005 3437 downloads

14.

Aerobic exercise improves the inflammatory profile correlated with cardiac remodeling and function in chronic heart failure rats
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Nunes, Ramiro B.

; Alves, Jadson P.

; Kessler, Luíza P.

; Lago, Pedro Dal

Clinics

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jun 2013, Volume 68 N. 6 Pages 876 - 882

Abstract: En | Text: En | PDF: En

OBJECTIVE: The aim of the present study was to evaluate the effect of 8 weeks of aerobic exercise training on cardiac functioning and remodeling and on the plasma levels of inflammatory cytokines in chronic heart failure rats. METHODS: Wistar rats were subjected to myocardial infarction or sham surgery and assigned to 4 groups: chronic heart failure trained (n = 7), chronic heart failure sedentary (n = 6), sham trained (n = 8) and sham sedentary (n = 8). Four weeks after the surgical procedures, the rats were subjected to aerobic training in the form of treadmill running (50 min/day, 5 times per week, 16 m/min). At the end of 8 weeks, the rats were placed under anesthesia, the hemodynamic variables were recorded and blood samples were collected. Cardiac hypertrophy was evaluated using the left ventricular weight/body weight ratio, and the collagen volume fraction was assessed using histology. RESULTS: The chronic heart failure trained group showed a reduction in left ventricular end-diastolic pressure, a lower left ventricular weight/body weight ratio and a lower collagen volume fraction compared with the chronic heart failure sedentary group. In addition, exercise training reduced the plasma levels of TNF-α and IL-6 and increased the plasma level of IL-10. CONCLUSION: An 8-week aerobic exercise training program improved the inflammatory profile and cardiac function and attenuated cardiac remodeling in chronic heart failure rats.

https://doi.org/10.6061/clinics/2013(06)24 2586 downloads

15.

Treinamento muscular inspiratório em pacientes com insuficiência cardíaca: metanálise de estudos randomizados
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Plentz, Rodrigo Della Méa

; Sbruzzi, Graciele

; Ribeiro, Rodrigo Antonini

; Ferreira, Janaína Barcellos

; Dal Lago, Pedro

Arquivos Brasileiros de Cardiologia

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aug 2012, Volume 99 N. 2 Pages 762 - 771

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Pacientes com Insuficiência Cardíaca Crônica (ICC) podem ter menor força e resistência muscular inspiratória, o que pode contribuir para a intolerância ao exercício. O Treinamento Muscular Inspiratório (TMI) tem demonstrado efeitos benéficos nesses pacientes. Dessa forma, o objetivo desse estudo foi revisar sistematicamente os efeitos do TMI comparado a grupo controle (TMI placebo ou outra intervenção) em pacientes com ICC. A busca incluiu as bases MEDLINE, PEDro e Cochrane CENTRAL, além de referências de estudos publicados, de 1960 a 2011. Ensaios randomizados comparando TMI e grupo controle no tratamento de pacientes com ICC foram incluídos. O GRADE foi utilizado para determinar a qualidade da evidência para cada desfecho. Dos 119 artigos identificados, sete estudos foram incluídos. O TMI aumentou a distância percorrida no teste de caminhada de 6 minutos [69 m (IC95%: 7,21 a 130,79)] (evidência muito baixa) e a pressão inspiratória máxima [23,36 cmH20 (IC95%: 11,71 a 35,02)] comparado aos grupos controles (evidência baixa). Entretanto, o TMI promoveu uma melhora significativa no consumo máximo de oxigênio somente nos estudos que realizaram TMI por 12 semanas, comparado a nenhuma carga inspiratória em pacientes com fraqueza muscular inspiratória [3,02 ml/kg/min-1 (IC95%: 0,43 a 5,61)]. Assim, concluiu-se que o TMI melhora capacidade funcional e força muscular inspiratória, merecendo consideração como uma intervenção adicional em pacientes com ICC. Entretanto, estudos maiores e com maior qualidade são necessários para esclarecer o potencial benefício do TMI nessa população.

Patients with chronic heart failure (CHF) may have lower inspiratory muscle strength and endurance, which may contribute to exercise intolerance. Inspiratory muscle training (IMT) can have beneficial effects on these patients. Thus, the aim of this study was to systematically review the effects of IMT compared to control groups (placebo-IMT or another intervention) in patients with CHF. A search of databases (MEDLINE, Cochrane CENTRAL and PEDro) and references of published studies, from 1960 to 2011, was conducted. Randomized trials comparing IMT to control groups in the treatment of patients with CHF were included. The GRADE approach was used to determine the quality of evidence for each outcome. Of 119 articles identified, 7 studies were included. IMT increased the distance walked in the six-minute walk test [69 m (95% CI: 7.21 to 130.79)] (very low evidence) and maximal static inspiratory pressure [23.36 cmH20 (95% CI: 11.71 to 35.02)] (low evidence) compared to control groups. However, IMT provides a significant improvement in peak oxygen consumption only in the studies that performed IMT for 12 weeks against no inspiratory load in patients with inspiratory muscle weakness [3.02 ml/kg/min-1 (95% CI: 0.43 to 5.61)]. IMT improves functional capacity and inspiratory muscle strength thereby deserving consideration as an additional intervention in patients with CHF. Larger and better-designed studies, however, are needed to clarify the potential benefit of IMT in this patient population.

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