Anderson Zampier Ulbrich

Validation of the International Index of Erectile Function (IIFE) for use in Brazil.

Background The International Index of Erectile Function has been proposed as a method for assessing sexual function assisting the diagnosis and classification of erectile dysfunction. However, IIEF was not validated for the Portuguese language. Objective Validate the International Index of Erectile Function in patients with cardiopulmonary and metabolic diseases. Methods The sample consisted of 108 participants of to Cardiopulmonary and Metabolic program Rehabilitation (CPMR) in southern Brazil. The clarity assessment of the instrument was performed using a scale ranging from zero to 10. The construct validity was carried out by confirmatory factor analysis (KMO = 0.85; Barllet p < 0.001), internal consistency by Cronbachs alpha and reproducibility and interrater reliability via the test retest method. Results The items were considered very clear with averages superior to 9. The internal consistency resulted in 0.89. The majority of items related correctly with their domains, with exception of three questions from sexual satisfaction domain, and one from erectile function. All items showed excellent stability of measure and substantial to almost perfect agreement. Conclusion The present study showed that the IIEF is valid and reliable for use in participants of a cardiopulmonary and metabolic rehabilitation program.

Probabilidade de hipertensão arterial a partir de indicadores antropométricos em adultos

OBJECTIVE: To associate anthropometric measures with arterial hypertension and develop a mathematical model to estimate this probability. SUBJECTS AND METHODS: A cross-sectional study was carried out with 3,445 adults of both sexes, between 18 and 60 years of age. Body mass index (BMI), waist-to-height ratio (WHR), waist circumference (HC), in addition age and sex were assessed. Blood pressure (BP) was measured and classified according to World Health Organization (WHO) and Brazilian Society of Hypertension (SBH) recommendations, using frequency analyses, correlation and logistic regression between variables, with p < 0.05. RESULTS: Males were twice as likely as woman to have hypertension, and for each year of life, the chance of hypertension increased 1.04 times. Odds ratio of hypertension in overweight individual increased two times, and in obese subjects, four times. CONCLUSION: Changes in body composition with advancing age, especially in men, were associated with hypertension, and assessment of these changes was relevant in the identification of this disease.

Questionário nutricional simplificado de apetite (QNSA) para uso em programas de reabilitação cardiopulmonar e metabólica

This study aimed to translate and validate a Brazilian version of the Simplified Nutritional Appetite Questionnaire (SNAQ), checking its clarity and validity for the participants of the Cardiopulmonary and Metabolic Rehabilitation Program (CPMR). One hundred and forty-six subjects were interviewed: 79 males, mean age of 63 years (±10) and 67 women, mean age of 66 years (±11). Descriptive analysis was presented as mean, standard deviation and frequency. The internal consistency of the scale was assessed using Cronbachs alpha coefficient and factor analysis by the method of extraction of principal components analysis using Kaisers criteria (eigenvalues > 1). All questions of the instrument showed positive results regarding clarity. The questionnaire items presented factor loadings above 0.40, (ranging from 0.40 to 0.81). Except for the issue related to the amount of daily meals, all others showed high correlation with the total score of the Brazilian version. Regarding the analysis of internal consistency, the result of 0.61 was reached. In conclusion, the Brazilian Version of SNAQ proved to be valid for use in CPMR program participants, thus becoming an important tool in assessing the appetite of the Brazilian population.

Avaliação do sistema locomotor de pacientes de programas de reabilitação cardiopulmonar e metabólica

BACKGROUND Participants of cardiopulmonary and metabolic rehabilitation (CPMR) programs may present with musculoskeletal changes that may affect treatment compliance and effectiveness. OBJECTIVE To develop an instrument for evaluation of the musculoskeletal system and identification of problems, especially those related to exercise, so that patients can be cleared to exercise with no restrictions, cleared with restrictions, or not cleared before approval from a specialist. METHODS Construction and validation (according to Cronbachs alpha) of a musculoskeletal system assessment inventory (MSSAI), for subsequent administration to participants in CPMR programs. RESULTS A total of 103 individuals participating in CPMR programs were evaluated by means of the MSSAI, whose internal validity and reliability proved to be satisfactory. Of these, 33 were men (32%) and 70 were women (68%), with age ranging from 36 to 84 years; 47 (45.6%) had already been diagnosed with musculoskeletal system disorders; 39 (37.9%) had already received specific treatment for the musculoskeletal system; 33 (32%) used to take medications to relieve symptoms related to the musculoskeletal system; and 10 (9.7%) had a medical restriction for performing some type of exercise. We should point out that 48 individuals (46.6%) reported pain in the musculoskeletal system; in 14 (13.6%) of them, the pain worsened by exercise, and this should have prevented them from participating in exercise programs before receiving approval from a specialist. CONCLUSION The MSSAI, whose internal validity and reliability proved satisfactory, showed that there was some restriction to exercise practice for almost half of the individuals participating in CPMR programs, and that some of them should not have been cleared without approval from a specialist.

Capacidade funcional como preditor de qualidade de vida na insuficiência cardíaca

Abstract Introduction : Heart failure (HF) affects the quality of life (QoL), while metabolic and cardiopulmonary rehabilitation program (MCRP) of patients with the syndrome provides improved functional capacity (FC) and QoL. Objectives : To determine the relationship of the QoL domains with CF in patients with HF and propose cutoff points of the QoL domains by CF. Materials and methods : We evaluated 57 patients with HF functional, class II and III, with 37 beginners (GI) in MCRP and 20 participants (GP) with more than three-month program. QoL was evaluated by the Minnesota through the physical, emotional, and general dimension domains. The CF was determined by testing the six-minute walk (6MWT), with cutoffs defined as proposed in the literature. We used the Student t test, Pearson correlation and ROC curve analysis to an-swer the research objectives, considering a 5% significance. Results : Participants of RCPM showed better QoL scores when compared to beginners. Significant correlations were observed between the Emotional Domain and 6MWT for both groups. There were significant cutoffs of domains of QoL arising from CF, highlighting the emotional domain (sensitivity/ specificity) for both groups.

Reposição hormonal e exercício físico no tratamento da insuficiência cardíaca: revisão sistemática

BACKGROUND: Despite the full use of pharmacological and non pharmacological therapy, morbidity and mortality incidence as a result from heart failure (HF) are still significantly persistent. In the therapeutic context is relevant the inhibition of the inadequate neuro-hormonal adaptations and metabolic, as well known the anabolic deficiency that develops in HF. But just recently some studies emerged about the benefits from the testosterone replacement or supplementation therapy (TRT). OBJECTIVE: Reviewing studies that address the TRT in heart failure (HF), particularly those developed in the ideal setting for clinical treatment, including physical exercise program. METHODS: It was analyzed the Scielo and Pubmed databases, Cochrane of Systematic Review and Clinical Control Trials from Cochrane Collaboration databases. RESULTS: The few studies about TRT in patients with HF showed improvement in of the hemodynamic function, insulin resistance, functional capacity and neuro-hormonal and neuromuscular responses, highlight the controversy regarding the influence on the inflammatory profile, and found no changes in function and structure in the central cardiovascular system. However, it has not been found studies about TRT associated with exercises program. CONCLUSION: the present state of knowledge, although based on a few studies, allows to considerate TRT in the treatment of patients with HF. It is not well-defined the ideal form of TRT, regarding to treatment duration, criteria for inclusion and exclusion, etc. There is a wide gap in the literature, calling attention to the lack of studies about TRT concomitant with full medical treatment, which includes an physical exercise program.

Exercício intenso e suplementação de testosterona em portadores de insuficiência cardíaca

^aINTRODUCAO: O sono e um estado natural e recorrente, no qual acontecem processos neurobiologicos importantes. A ma qualidade do sono esta diretamente A insuficiencia cardiaca (IC) e uma sindrome com alteracoes neuroendocrinas, limitacoes funcionais associadas a baixa qualidade de vida. Ha pouco conhecimento dos efeitos do exercicio fisico de alta intensidade e terapia de suplementacao de testosterona (TST) em portadores de IC e hipotestosteronemia.OBJETIVO: Avaliar os efeitos do exercicio de alta intensidade associado a TST na qualidade de vida e potencia aerobia destes pacientes.METODOS: Dezenove pacientes portadores de IC (idade media, 58 ± 10 anos; fracao de ejecao, 34 ± 8%) foram randomizados para o grupo exercicio de alta intensidade (controle; n=9) e exercicio de alta intensidade com suplementacao hormonal (intervencao; n=10). Os Pacientes exercitaram-se (40 minutos, 90% do consumo maximo de oxigenio) tres vezes semanalmente durante 12 semanas. O grupo intervencao recebeu testosterona na primeira e sexta semanas. Antes e apos o periodo de estudo foram obtidas medidas da capacidade funcional e escores do Minnesota Living with Heart Failure Questionnaire.RESULTADOS: No intragrupo controle e intervencao, respectivamente, houve aumento do pico de consumo de oxigenio (12% vs. 15%; p CONCLUSAO: Exercicio de alta intensidade melhora a capacidade funcional e escores da QV apos 12 semanas de tratamento.^lpt^aINTRODUCTION: Heart failure is a syndrome related to neuroendocrine alterations and limitations on daily activities associated with poor quality of life. Little is known about the effects of high-intensity exercise and testosterone supplementation therapy (TST) on heart failure patients with hypotestosteronemia.OBJECTIVE: To evaluate the effects of high-intensity exercise and testosterone supplementation on quality of life and aerobic power in these patients.METHODS: Nineteen heart failure patients (age=58 ± 10 years; ejection fraction= 34 ± 8%) were randomized to either a high-intensity exercise group (control; n=9) or high-intensity exercise group with hormonal supplementation (intervention; n=10). Patients exercised (40 minutes, 90% peak oxygen consumption) for 12 weeks, three times weekly and intervention group received testosterone in the first and sixth weeks. Functional capacity measurements and Minnesota Living With Heart Failure Questionnaire (MLWHFQ) scores were obtained before and after the study period.RESULTS: Within control and intervention group respectively there was an increase in peak oxygen uptake (12% vs. 15%; pCONCLUSION: High-intensity exercise improves functional capacity and quality of life scores after 12 weeks of treatment.^len^aINTRODUCCION: La insuficiencia cardiaca (IC) es un sindrome con alteraciones neuroendocrinas, limitaciones funcionales asociadas a la baja calidad de vida. Hay poco conocimiento de los efectos del ejercicio fisico de alta intensidad y terapia de suplementacion de testosterona (TST) en portadores de IC e hipotestosteronemia.OBJETIVO: Evaluar los efectos del ejercicio de alta intensidad asociado a TST en la calidad de vida y potencia aerobica de estos pacientes.METODOS:Diecinueve pacientes portadores de IC (promedio de edad= 58 ± 10 anos; fraccion de eyeccion= 34 ± 8%) fueron randomizados para el grupo ejercicio de alta intensidad (control; n=9) y ejercicio de alta intensidad con suplementacion hormonal (intervencion; n=10). Los pacientes se ejercitaron (40 minutos, 90% del consumo maximo de oxigeno) tres veces semanalmente por 12 semanas, el grupo intervencion recibio testosterona en la primera y sexta semanas. Antes y despues del periodo de estudio fueron obtenidas medidas de la capacidad funcional y escores del Minnesota Living with Heart Failure Questionnaire.RESULTADOS: Intragrupo control e intervencion respectivamente hubo aumento del pico de consumo de oxigeno (12% vs. 15%; pCONCLUSIONES: El ejercicio de alta intensidad mejora la capacidad funcional y escores de la CV despues de 12 semanas de tratamiento.^les