Carlos Hermano da Justa Pinheiro

Modificação do padrão respiratório melhora o controle cardiovascular na hipertensão essencial

BACKGROUND Recent studies show that controlled breathing improves baroreflex and heart rate variability and lowers blood pressure in hypertensive patients. OBJECTIVE To evaluate the effects of slow breathing training on cardiorespiratory system modulation of patients (n=10, men and women, ages ranging from 45 to 60) with essential hypertension seen in an outpatient setting. METHODS According to the study design, each patient was used as his/her own control, and data were collected before and after the intervention. The following parameters were assessed: heart rate variability (HRV), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP), respirometry, chest expansion measurement, and statistical data analysis. Respiratory training was performed in 30-minute sessions held twice a week over one month using slow breathing exercises. RESULTS Our results were as follows: a reduction in SBP, DPB, and MAP (p < 0.05 vs control); an increase in heart rate variability, as evidenced by greater RR interval variation and SDNN index; a decline in respiratory rate (p < 0.01 vs control); and an increase in tidal volume (p < 0.01 vs control) and thoracic expansibility (p < 0.01 vs control). CONCLUSION Respiratory retraining using the slow breathing technique appears to be a useful adjunctive for cardiorespiratory control in hypertensive patients.

Exercise prevents cardiometabolic alterations induced by chronic use of glucocorticoids

FUNDAMENTO: Cronicamente, os glicocorticoides induzem alteracoes cardiometabolicas adversas, incluindo resistencia a insulina, diabete, dislipidemia, esteatose hepatica e hipertensao arterial. OBJETIVOS: Avaliar o efeito da pratica regular de exercicio fisico aerobio sobre as alteracoes cardiometabolicas induzidas por administracao cronica de dexametasona (Dex - 0,5 mg/kg/dia i.p) em ratos. METODOS: Ratos Wistar machos (n = 24) foram divididos em quatro grupos: Grupo controle; Grupo treinado; Grupo tratado com Dex e Grupo tratado com Dex e treinado. O treinamento fisico (iniciado 72 horas apos a primeira dose de Dex) foi realizado 3 vezes por semana, ate o final do tratamento. Ao final desse periodo, realizaram-se as seguintes avaliacoes bioquimicas: glicemia em jejum, teste de tolerância a glicose e analise do perfil lipidico no sangue que incluiu colesterol total (CT), LDL-c, HDL-c, VLDL-c e triglicerideos (TG). O peso do musculo gastrocnemio, analise histopatologica do figado e os indices cardiometabolicos (CT/HDL-c, LDL-c/HDL-c e TG/HDL-c) tambem foram avaliados. RESULTADOS: Observou-se hiperglicemia, menor tolerância a glicose, elevacao do CT, LDL-c, VLDL-c e TG, diminuicao do HDL-c, presenca de esteatose hepatica, hipotrofia muscular e elevacao dos indices CT/HDL-c, LDL-c/HDL-c e TG/HDL-c nos animais tratados com Dex. O exercicio fisico reduziu a hiperglicemia, melhorou a tolerância a glicose, reduziu a dislipidemia e preveniu a esteatose hepatica , a hipotrofia muscular e reduziu os indices CT/HDL-c, LDL-c/HDL-c e TG/HDL-c. Entretanto, nao houve efeito significante do treinamento fisico sobre o HDL-c. CONCLUSAO: O exercicio fisico aerobio tem efeito protetor contra as alteracoes cardiometabolicas induzidas pelo uso cronico de glicocorticoides.BACKGROUND Chronically, glucocorticoids induce adverse cardiometabolic alterations including insulin resistance, diabetes, dyslipidemia, liver steatosis and arterial hypertension. OBJECTIVES To evaluate the effect of regular practice of aerobic exercise on cardiometabolic alterations induced by chronic administration of dexamethasone (Dex - 0.5 mg/kg/day ip) in rats. METHODS Male Wistar rats (n = 24) were divided in four groups: Control group; Trained group; Treated with Dex group and Treated with Dex and trained group. The exercise training (initiated 72 hours after the first dose of Dex) was carried out three times a week until the end of the treatment. At the end of this period, the following biochemical assessments were performed: fasting glycemia, oral glucose tolerance test and analysis of the blood lipid profile that included total cholesterol (TC), LDL-c, HDL-c, VLDL-c and triglycerides (TG). The weight of the gastrocnemius muscle, the histopathological analysis of the liver and cardiometabolic indices (TC/HDL-c, LDL-c/HDL-c and TG/HDL-c) were also performed. RESULTS Hyperglycemia, lower glucose tolerance, increased TC, LDL-c, VLDL-c, TG, CT/HDL-c, LDL-c/HDL-c and TG/HDL-c, decreased HDL-c, presence of liver steatosis and muscular hypotrophy were observed in the animals treated with Dex. The exercise training reduced hyperglycemia, improved glucose tolerance, decreased dyslipidemia and prevented liver steatosis, muscular hypotrophy and reduced CT/HDL-c, LDL-c/HDL-c and TG/HDL-c ratios. However, there was no significant effect on HDL-c. CONCLUSION The aerobic exercise training have a protective effect against the cardiometabolic alterations induced by the chronic use of glucocorticoids.

Exercício físico previne alterações cardiometabólicas induzidas pelo uso crônico de glicocorticóides

FUNDAMENTO: Cronicamente, os glicocorticoides induzem alteracoes cardiometabolicas adversas, incluindo resistencia a insulina, diabete, dislipidemia, esteatose hepatica e hipertensao arterial. OBJETIVOS: Avaliar o efeito da pratica regular de exercicio fisico aerobio sobre as alteracoes cardiometabolicas induzidas por administracao cronica de dexametasona (Dex - 0,5 mg/kg/dia i.p) em ratos. METODOS: Ratos Wistar machos (n = 24) foram divididos em quatro grupos: Grupo controle; Grupo treinado; Grupo tratado com Dex e Grupo tratado com Dex e treinado. O treinamento fisico (iniciado 72 horas apos a primeira dose de Dex) foi realizado 3 vezes por semana, ate o final do tratamento. Ao final desse periodo, realizaram-se as seguintes avaliacoes bioquimicas: glicemia em jejum, teste de tolerância a glicose e analise do perfil lipidico no sangue que incluiu colesterol total (CT), LDL-c, HDL-c, VLDL-c e triglicerideos (TG). O peso do musculo gastrocnemio, analise histopatologica do figado e os indices cardiometabolicos (CT/HDL-c, LDL-c/HDL-c e TG/HDL-c) tambem foram avaliados. RESULTADOS: Observou-se hiperglicemia, menor tolerância a glicose, elevacao do CT, LDL-c, VLDL-c e TG, diminuicao do HDL-c, presenca de esteatose hepatica, hipotrofia muscular e elevacao dos indices CT/HDL-c, LDL-c/HDL-c e TG/HDL-c nos animais tratados com Dex. O exercicio fisico reduziu a hiperglicemia, melhorou a tolerância a glicose, reduziu a dislipidemia e preveniu a esteatose hepatica , a hipotrofia muscular e reduziu os indices CT/HDL-c, LDL-c/HDL-c e TG/HDL-c. Entretanto, nao houve efeito significante do treinamento fisico sobre o HDL-c. CONCLUSAO: O exercicio fisico aerobio tem efeito protetor contra as alteracoes cardiometabolicas induzidas pelo uso cronico de glicocorticoides.BACKGROUND Chronically, glucocorticoids induce adverse cardiometabolic alterations including insulin resistance, diabetes, dyslipidemia, liver steatosis and arterial hypertension. OBJECTIVES To evaluate the effect of regular practice of aerobic exercise on cardiometabolic alterations induced by chronic administration of dexamethasone (Dex - 0.5 mg/kg/day ip) in rats. METHODS Male Wistar rats (n = 24) were divided in four groups: Control group; Trained group; Treated with Dex group and Treated with Dex and trained group. The exercise training (initiated 72 hours after the first dose of Dex) was carried out three times a week until the end of the treatment. At the end of this period, the following biochemical assessments were performed: fasting glycemia, oral glucose tolerance test and analysis of the blood lipid profile that included total cholesterol (TC), LDL-c, HDL-c, VLDL-c and triglycerides (TG). The weight of the gastrocnemius muscle, the histopathological analysis of the liver and cardiometabolic indices (TC/HDL-c, LDL-c/HDL-c and TG/HDL-c) were also performed. RESULTS Hyperglycemia, lower glucose tolerance, increased TC, LDL-c, VLDL-c, TG, CT/HDL-c, LDL-c/HDL-c and TG/HDL-c, decreased HDL-c, presence of liver steatosis and muscular hypotrophy were observed in the animals treated with Dex. The exercise training reduced hyperglycemia, improved glucose tolerance, decreased dyslipidemia and prevented liver steatosis, muscular hypotrophy and reduced CT/HDL-c, LDL-c/HDL-c and TG/HDL-c ratios. However, there was no significant effect on HDL-c. CONCLUSION The aerobic exercise training have a protective effect against the cardiometabolic alterations induced by the chronic use of glucocorticoids.

Considerações sobre a reabilitação física e fisioterapia nas alterações cinesiológicas e funcionais em um caso de pênfigo foliáceo endêmico - doi:10.5020/18061230.2007.p124

The pemphigus foliaceus is a very common skin disease in the Center-West region of Brazil and is named endemic due to its incidence in some regions of the country, South America and Latin America. In Northeast Brazil, the pemphigus foliaceus is considered a rare disease. The bearers of endemic pemphigus foliaceus show an intense healing process associated with metabolic alterations that affect the skeletal muscle and can compromise in different ways the kinesiology of the locomotor apparatus. The aim of this study was to describe a pemphigus foliaceus case in Ceara state, focusing on the postural and functional aspects of the locomotor apparatus in the clinical evolution of the disease. Case report: A pediatric patient bearer of endemic pemphigus foliaceus, resident at a mountain region of Ceara, with clinical data consisting of erythematous lesions, crusts, few visible vesicle-blister lesions, intense itch, cutaneous adhesions, postural deformities and alterations in the flexor tonus of the limbs, compromising movement extent. The physiotherapeutic protocol prescribed consisted of active exercises, inhibition of flexor tonus, passive elongation and walk training. After 3 weeks, the patient was already strolling and showed improvement in muscular and joint function. The physiotherapy when precociously done can prevent the formation of cutaneous adhesions and muscular weakness, preserving the range of motion present in diseases with an intense healing process such as endemic pemphigus foliaceus.

Comprometimento do desenvolvimento pondo-estatural em crianças portadoras de cardiopatias congênitas com Shunt Cianogênico - doi:10.5020/18061230.2008.p98

Objective: To identify changes in the growth and physical development of children with cyanotic congenital heart disease (CCHD). Methods: This was a cross-sectional and descriptive study. We studied 30 children with CCHD aged 0-8 years-old. The analysed variables were: prevalence of gender involvement, type of congenital heart anomaly and anthropometric indices (Weight/Age, Height/Age and Weight/Height) which were compared with the standards values proposed for the age in accordance with the scale of growth and child development of the National Center for Health Statistics (NCHS). Results: There was a greater involvement of males and the most prevalent CCHD were the Fallot’s Tetralogy and Double transposition of the great vessels. Among children with CCHD, 90% had a lower Weight/Age index, 83% had a lower Height/Age index and 97% had a lower Weight/Height index. Conclusion: Children with CCHD show a high prevalence of growth and development retardation compared to the standard values of the NCHS. The nutritional assistance and encouragement for the practice of physical activity would have an important role in physical rehabilitation after the surgical correction of congenital heart defect in children with CCHD.

Estilo de vida e importância da educação em saúde na reabilitação cardíaca após cirurgia de revascularização do miocárdio - doi:10.5020/18061230.2007.p213

In the treatment of ischemic cardiopathy, the prevention has a main role and the modifications in the lifestyle are indispensable for the good prognosis of the disease. The goal of the study was to describe the lifestyle regarding the prevalence of cardiovascular risk factors, such as smoking, alcohol consumption, dietary habits and sedentary behaviors before myocardial revascularization surgery and during the period of cardiac rehabilitation in a private institution that did not comprise structured health education activities. This was a retrospective, observational study, with a qualitative approach, held with 50 patients submitted to cardiac rehabilitation (36 men and 14 women; age 61±12.74 years). The data were collected from clinical records of the pre-cardiac rehabilitation evaluation which consisted of clinical data and information referring to the patients’ lifestyle. Amongst the most prevalent co-morbidities in the sample, there were: the hypertension (n=24; 48%), the diabetes mellitus (n=18; 36%) and dyslipidemias (n=17; 34%). A high rate of smoke cessation (100%) and 58% of sedentary behaviors (n=29) was observed after the cardiac surgery. This same number (n=29; 58%) referred to have adhered to changes in dietary habits after the myocardial acute infarct. There was also an increase in the prevalence of alcohol consumption (n=21; 42%) after myocardial revascularization. We conclude with this research that a cardiac rehabilitation program should provide to their patients, health education actions, for a necessary and real change in lifestyle habits, with the presence of a multidisciplinary team.

Ejercicio físico previene alteraciones cardiometabólicas inducidas por el uso crónico de glucocorticoides

FUNDAMENTO: Cronicamente, os glicocorticoides induzem alteracoes cardiometabolicas adversas, incluindo resistencia a insulina, diabete, dislipidemia, esteatose hepatica e hipertensao arterial. OBJETIVOS: Avaliar o efeito da pratica regular de exercicio fisico aerobio sobre as alteracoes cardiometabolicas induzidas por administracao cronica de dexametasona (Dex - 0,5 mg/kg/dia i.p) em ratos. METODOS: Ratos Wistar machos (n = 24) foram divididos em quatro grupos: Grupo controle; Grupo treinado; Grupo tratado com Dex e Grupo tratado com Dex e treinado. O treinamento fisico (iniciado 72 horas apos a primeira dose de Dex) foi realizado 3 vezes por semana, ate o final do tratamento. Ao final desse periodo, realizaram-se as seguintes avaliacoes bioquimicas: glicemia em jejum, teste de tolerância a glicose e analise do perfil lipidico no sangue que incluiu colesterol total (CT), LDL-c, HDL-c, VLDL-c e triglicerideos (TG). O peso do musculo gastrocnemio, analise histopatologica do figado e os indices cardiometabolicos (CT/HDL-c, LDL-c/HDL-c e TG/HDL-c) tambem foram avaliados. RESULTADOS: Observou-se hiperglicemia, menor tolerância a glicose, elevacao do CT, LDL-c, VLDL-c e TG, diminuicao do HDL-c, presenca de esteatose hepatica, hipotrofia muscular e elevacao dos indices CT/HDL-c, LDL-c/HDL-c e TG/HDL-c nos animais tratados com Dex. O exercicio fisico reduziu a hiperglicemia, melhorou a tolerância a glicose, reduziu a dislipidemia e preveniu a esteatose hepatica , a hipotrofia muscular e reduziu os indices CT/HDL-c, LDL-c/HDL-c e TG/HDL-c. Entretanto, nao houve efeito significante do treinamento fisico sobre o HDL-c. CONCLUSAO: O exercicio fisico aerobio tem efeito protetor contra as alteracoes cardiometabolicas induzidas pelo uso cronico de glicocorticoides.BACKGROUND Chronically, glucocorticoids induce adverse cardiometabolic alterations including insulin resistance, diabetes, dyslipidemia, liver steatosis and arterial hypertension. OBJECTIVES To evaluate the effect of regular practice of aerobic exercise on cardiometabolic alterations induced by chronic administration of dexamethasone (Dex - 0.5 mg/kg/day ip) in rats. METHODS Male Wistar rats (n = 24) were divided in four groups: Control group; Trained group; Treated with Dex group and Treated with Dex and trained group. The exercise training (initiated 72 hours after the first dose of Dex) was carried out three times a week until the end of the treatment. At the end of this period, the following biochemical assessments were performed: fasting glycemia, oral glucose tolerance test and analysis of the blood lipid profile that included total cholesterol (TC), LDL-c, HDL-c, VLDL-c and triglycerides (TG). The weight of the gastrocnemius muscle, the histopathological analysis of the liver and cardiometabolic indices (TC/HDL-c, LDL-c/HDL-c and TG/HDL-c) were also performed. RESULTS Hyperglycemia, lower glucose tolerance, increased TC, LDL-c, VLDL-c, TG, CT/HDL-c, LDL-c/HDL-c and TG/HDL-c, decreased HDL-c, presence of liver steatosis and muscular hypotrophy were observed in the animals treated with Dex. The exercise training reduced hyperglycemia, improved glucose tolerance, decreased dyslipidemia and prevented liver steatosis, muscular hypotrophy and reduced CT/HDL-c, LDL-c/HDL-c and TG/HDL-c ratios. However, there was no significant effect on HDL-c. CONCLUSION The aerobic exercise training have a protective effect against the cardiometabolic alterations induced by the chronic use of glucocorticoids.