Cristiano Sena Conceição

A systematic review of the effects of different types of therapeutic exercise on physiologic and functional measurements in patients with HIV/AIDS

Several studies have reported the benefits of exercise training for adults with HIV, although there is no consensus regarding the most efficient modalities. The aim of this study was to determine the effects of different types of exercise on physiologic and functional measurements in patients with HIV using a systematic strategy for searching randomized controlled trials. The sources used in this review were the Cochrane Library, EMBASE, MEDLINE, and PEDro from 1950 to August 2012. We selected randomized controlled trials examining the effects of exercise on body composition, muscle strength, aerobic capacity, and/or quality of life in adults with HIV. Two independent reviewers screened the abstracts using the Cochrane Collaborations protocol. The PEDro score was used to evaluate methodological quality. In total, 29 studies fulfilled the inclusion criteria. Individual studies suggested that exercise training contributed to improvement of physiologic and functional parameters, but that the gains were specific to the type of exercise performed. Resistance exercise training improved outcomes related to body composition and muscle strength, with little impact on quality of life. Aerobic exercise training improved body composition and aerobic capacity. Concurrent training produced significant gains in all outcomes evaluated, although moderate intensity and a long duration were necessary. We concluded that exercise training was shown to be a safe and beneficial intervention in the treatment of patients with HIV.

Effects of Combined Aerobic and Resistance Exercise on Exercise Capacity, Muscle Strength and Quality of Life in HIV-Infected Patients: A Systematic Review and Meta-Analysis.

Background Many HIV-infected patients demonstrate disability and lower aerobic capacity. The inclusion of resistance training combined with aerobic exercise in a single program is known as combined aerobic and resistance exercise (CARE) and seems to be an effective strategy to improve muscle weakness, as well as aerobic capacity in HIV-infected patients. We performed a meta-analysis to investigate the effects of CARE in HIV-infected patients. Methods We searched MEDLINE, Cochrane Controlled Trials Register, EMBASE, CINAHL (from the earliest date available to august 2014) for controlled trials that evaluated the effects of CARE in HIV-infected patients. Weighted mean differences (WMD) and 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed using the I2 test. Results Seven studies met the study criteria. CARE resulted in improvement in Peak VO2 WMD (4.48 mL·kg-1·min-1 95% CI: 2.95 to 6.0), muscle strength of the knee extensors WMD (25.06 Kg 95% CI: 10.46 to 39.66) and elbow flexors WMD (4.44 Kg 95% CI: 1.22 to 7.67) compared with no exercise group. The meta-analyses also showed significant improvement in Health status, Energy/Vitality and physical function domains of quality of life for participants in the CARE group compared with no exercise group. A nonsignificant improvement in social function domain of quality of life was found for participants in the CARE group compared with no exercise group. Conclusions Combined aerobic and resistance exercise may improve peak VO2, muscle strength and health status, energy and physical function domains of quality of life and should be considered as a component of care of HIV-infected individuals.

Effects of Respiratory Muscle Training on Respiratory Function, Respiratory Muscle Strength, and Exercise Tolerance in Patients Poststroke: A Systematic Review With Meta-Analysis

OBJECTIVE To examine the effects of respiratory muscle training on respiratory function, respiratory muscle strength, and exercise tolerance in patients poststroke. DATA SOURCES We searched MEDLINE, Cochrane Library, Embase, SciELO, Physiotherapy Evidence Database (PEDro), and CINAHL (from the earliest date available to November 2015) for trials. STUDY SELECTION Randomized controlled trials (RCTs) that examined the effects of respiratory muscle training versus nonrespiratory muscle training in patients poststroke. Two reviewers selected studies independently. DATA EXTRACTION Extracted data from the published RCTs. Study quality was evaluated using the PEDro Scale. Weighted mean differences (WMDs), standard mean differences (SMDs), and 95% confidence intervals (CIs) were calculated. DATA SYNTHESIS Eight studies met the study criteria. Respiratory muscle training improved maximal inspiratory pressure WMDs (7.5; 95% CI, 2.7-12.4), forced vital capacity SMDs (2.0; 95% CI, 0.6-3.4), forced expiratory volume at 1 second SMDs (1.2; 95% CI, 0.6-1.9), and exercise tolerance SMDs (0.7; 95% CI, 0.2-1.2). No serious adverse events were reported. CONCLUSIONS Respiratory muscle training should be considered an effective method of improving respiratory function, inspiratory muscle strength, and exercise tolerance in patients poststroke. Further research is needed to determine optimum dosages and duration of effect.

Effects of the FIFA 11 training program on injury prevention and performance in football players: a systematic review and meta-analysis

Objective: To investigate the effects of FIFA 11 training on injury prevention and performance in football players. Design and methods: Systematic review and meta-analysis. We conducted a systematic search using four databases (CINAHL, Cochrane Library, EMBASE, and PubMed) to find controlled trials evaluating the effects of FIFA 11 on injury prevention and performance among football players. Weighted mean differences, standard mean differences, risk ratios, and 95% confidence intervals were calculated, and heterogeneity was assessed using the I2 test. Results: We analyzed 11 trials, including 4700 participants. FIFA 11 resulted in a significant reduction in injury risk (risk ratio = 0.69; 95% confidence interval, 0.49–0.98; P = 0.02) and improvements in dynamic balance (weighted mean difference = 2.68; 95% confidence interval, 0.44–4.92; P = 0.02) and agility (standard mean difference = −0.36; 95% confidence interval, 0.70–0.02; P = 0.04). The meta-analysis indicated a non-significant improvement in jump height (standard mean difference = 0.25; 95% confidence interval, 0.08–0.59; P = 0.14) and running sprint (standard mean difference = −0.24; 95% confidence interval, 0.58–0.10; P = 0.17) in the FIFA 11 group. Conclusions: FIFA 11 can be considered as a tool to reduce the risk of injury. It may improve dynamic balance and agility and can be considered for inclusion in the training of football players.

Combined Exercise and Inspiratory Muscle Training in Patients With Heart Failure: A SYSTEMATIC REVIEW AND META-ANALYSIS.

PURPOSE: Studies have reported the benefits of exercise and inspiratory muscle training (IMT) in patients with heart failure (HF); however, there is no meta-analysis on the effects of the combination of exercise and IMT in patients with HF. The objective of this study was to determine whether combined exercise/IMT was more effective than conventional exercise on exercise capacity, respiratory muscle strength, and quality of life in patients with HF. METHODS: This is a systematic review and meta-analysis. We searched MEDLINE, LILACS, CINAHL, EMBASE, PEDro, and the Cochrane Central Register of Controlled Trials (from the earliest date available to April 2015) for randomized controlled trials, examining effects of combined exercise/IMT versus conventional exercise on exercise capacity, respiratory muscle strength, and quality of life measurements in patients with HF. Two reviewers selected studies independently. Weighted mean differences and 95% CIs were calculated. RESULTS: Three studies met the study criteria. Combined exercise/IMT resulted in improvement in maximal inspiratory pressure weighted mean differences (20.89 cm H2O; 95% CI, 14.0-27.78) and Minnesota Living with Heart Failure Questionnaire weighted mean differences (4.43; 95% CI, 0.72-8.14). Nonsignificant difference was observed in peak O2 for participants in the combined exercise/IMT group compared with the conventional exercise group. No serious adverse events were reported. CONCLUSIONS: Combined exercise/IMT may improve maximal inspiratory pressure and quality of life in patients with HF and should be considered for inclusion in cardiac rehabilitation programs.

Analysis of the psychometric properties of the American Orthopaedic Foot and Ankle Society Score (AOFAS) in rheumatoid arthritis patients: application of the Rasch model

OBJECTIVE To tested the reliability and validity of Aofas in a sample of rheumatoid arthritis patients. METHODS The scale was applicable to rheumatoid arthritis patients, twice by the interviewer 1 and once by the interviewer 2. The Aofas was subjected to test-retest reliability analysis (with 20 Rheumatoid arthritis subjects). The psychometric properties were investigated using Rasch analysis on 33 Rheumatoid arthritis patients. RESULTS Intra-Class Correlation Coefficient (ICC) were (0.90<ICC<0.95; p<0.001) for intra-observer reliability and (0.75<ICC<0.91; p<0.001) for inter-observer reliability. Subjects separation rates were 1.9 and 4.75 for the items, showing that patients fell into three ability levels, and the items were divided into six difficulties levels. The Rasch analysis showed that eight items was satisfactory. One erroneous item have been identified, showing percentages above the 5% allowed by the statistical model. Further Rasch modeling suggested revising the original item 8. CONCLUSIONS The results suggest that the Brazilian versions of Aofas exhibit adequate reliability, construct validity, response stability. These findings indicate that Aofas Ankle-Hindfoot scale presents a significant potential for clinical applicability in individuals with rheumatoid arthritis. Other studies in populations with other characteristics are now underway.

Aerobic capacity and health-related quality of life in adults HIV-infected patients with and without lipodystrophy

INTRODUCTION HIV infection and its therapy which can affect their aerobic capacity and health-related quality of life of patients. OBJECTIVE We conducted a cross-sectional study to determine if aerobic capacity and health related quality of life was decreased in HIV-infected patients receiving highly active antiretroviral therapy and comparing patients with and without lipodystrophy. RESEARCH DESIGN AND METHODS HIV-infected patients older than 18 years, and in current use of highly active antiretroviral therapy drugs, were evaluated for blood count, fasting total cholesterol, high density lipoprotein, triglycerides, glucose, HIV viral load and CD4/CD8 counts, body composition, peak oxygen consumption (peak VO2) and metabolic equivalent. Health related quality of life was assessed by using Short Form-36 (SF-36). Statistical analysis was carried out using SPSS version 20.0. RESULTS A total of 63 patients with mean age of 43.1±6.4 years were evaluated, of these 34 (54%) had lipodystrophy. The average peak VO2 (31.4±7.6mLkg(-1)min(-1)) was significantly lower (p<0.01) than expected values (37.9±5.6mLkg(-1)min(-1)) according to the characteristics of the patients. The lipodystrophy group presented with a significant difference in muscle mass, body fat, peak VO2 and metabolic equivalent and in functional capacity domains of SF-36. CONCLUSION Aerobic capacity values were reduced in HIV-infected patients under highly active antiretroviral therapy when compared to predicted values. Lipodystrophy was associated with reduced aerobic capacity and higher frequency of metabolic syndrome. Lifestyle modification should be a priority in the management of chronic HIV disease.

Hydrotherapy on exercise capacity, muscle strength and quality of life in patients with heart failure: A meta-analysis

Heart failure (HF) is clinically characterized by exercise intolerance, poor health related quality of life (HRQOL) and high mortality [1–3]. Exercise training is a well-established method to improve exercise intolerance and to restore HRQOL in patients with HF [4]. However, the most efficient modality is unknown. In this context, hydrotherapy (i.e. exercise in warm water) has been proposed as an alternative tool in the rehabilitation of patients with HF. There is no meta-analysis of the efficacy of this intervention in HF patients. The aim of this systematic review with meta-analysis was to analyze the published randomized controlled trials (RCTs) that investigated the effects of hydrotherapy on exercise capacity and HRQOL in HF patients. This reviewwas planned and conducted in accordancewith PRISMA (Preferred Reporting Items for Systematic Reviews andMeta-Analyses) guidelines [5]. We searched for references on MEDLINE, EMBASE, CINAHL, PEDro, and the Cochrane Library up to May 2014 without language restrictions. This systematic review included all RCTs that studied the effects of hydrotherapy in aerobic capacity, muscle strength and/or HRQOL of the HF patients. Two authors independently evaluated and extracted data from the published reports. Methodological quality was also independently

Effects of upper limb resistance exercise on aerobic capacity, muscle strength, and quality of life in COPD patients: a randomized controlled trial

Objective: To evaluate the effects of upper limb resistance exercise on the functional capacity, muscle function, and quality of life in patients with chronic obstructive pulmonary disease. Setting: Clinical School of Physiotherapy in a Public University of Brazil. Subjects: 58 patients were recruited; of these, 7 were excluded and 51 individuals were enrolled. Intervention: Control group performed warm-up, aerobic exercise, inspiratory muscle training, and session stretching, followed by massage therapy. The treatment group performed warm-up, aerobic exercise, inspiratory muscle training, three sets of upper limb resistance exercise, and session stretching, followed by massage therapy. Total three sessions per week for eight weeks. Primary outcome measures: 6-minute walk test, respiratory and peripheral muscle strength, dyspnea, and quality of life. Normality of the data was tested using the Shapiro–Wilk test; paired analysis of variance was used for intergroup analyses. Results: 51 patients (25 in the control group and 26 in the treatment group); 41% of the subjects were men. Mean forced expiratory volume was 2.6 ± 0.6 L, and mean body mass index was 27.3 ± 7.0 kg/m2. The upper limb resistance exercise resulted in significantly greater benefit in terms of exercise capacity (88.5 ± 81.9 m, P = 0.043), inspiratory muscle strength (22.9 ± 24.2 cm H2O, P = 0.001), upper limb muscle strength (2.3 ± 3.1 kg, P = 0.027), and quality of life scores (−15.3 ± 10.9 points, P = 0.000). Conclusion: Upper limb resistance exercise improved the exercise capacity, respiratory muscle strength, and quality of life.

Kinetic and Functional Impact of Foot Orthoses in Rheumatoid Arthritis Feet: A Randomized Clinical Trial

Objective: To verify the effectiveness of custom-molded FO (Foot Orthoses) on kinetic parameters, pain, and disability in RA patients. Methods: Patients with RA were randomized into FO and no orthoses groups. Kinetic parameters were assessed using a foot pressure system, foot pain was evaluated using the pain subscale of the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, and disability was evaluated by the total score of the AOFAS anklehindfoot scale and by the Health Assessment Questionnaire for RA. Results: Analyses were performed on data collected at baseline and after 2 months of intervention. Thirty-three women (mean age, 53.0 ± 10.97 years; mean disease duration, 12.2 ± 7.54 years) were evaluated. No differences in the kinetic parameters, and small, but non-significant, improvements in the pain and disability measures were observed in the FO group. Conclusions: FO without other conservative treatments did not have a significant effect on the pain and disability in RA patients. Additional, larger trials are needed to investigate the effects of these devices combined with physical therapy in similar patients. Trial registration: http://www.ensaiosclinicos.gov.br/rg/RBR-24ydf6/, RBR-24ydf6.