Gabriela Suéllen da Silva Chaves

Effects of pulmonary rehabilitation in lung transplant candidates: a systematic review

Objectives The aim of this systematic review of randomised controlled trials (RCTs), and quasi-experimental and retrospective studies is to investigate the effects of pulmonary rehabilitation (PR) in patients with advanced chronic disease on the waiting list for lung transplantation. Setting PR performed for inpatient or outpatient lung transplant candidates. Intervention PR programme including aerobic exercise training and/or resistance exercise training. Primary and secondary outcomes Quality of life and exercise capacity (primary outcomes). Survival rate after transplant surgery; pulmonary function; respiratory muscle strength; psychological aspects; upper and lower extremity muscle strength and adverse effects (secondary outcomes). Two review authors independently selected the studies, assessed study quality and extracted data. Studies in any language were included. Results This was a systematic review and studies were searched on the Cochrane Library, MEDLINE, EMBASE, CINAHL and PEDro. Experimental and retrospective studies evaluating the effects of PR in candidates for lung transplantation (>18u2005years old) with any lung diseases were included. 2 RCTs, and two quasi-experimental and two retrospectives studies, involving 1305 participants were included in the review. 5 studies included an enhancement reported in quality of life using the Short Form 36 questionnaire and showed improvements in some domains. All studies included exercise capacity evaluated through 6u2005min walk test and in five of them, there were improvements in this outcome after PR. Owing to the different characteristics of the studies, it was not possible to perform a meta-analysis. Conclusions Studies included in this review showed that PR is an effective treatment option for patients on the waiting list for lung transplantation and can improve quality of life and exercise capacity in those patients. Although individual studies reported positive effects of PR, this review shows that there is a need for more studies of a high methodological quality addressing PR effects in lung transplant candidates. Trial registration number PROSPERO CDR42015025110.

Health literacy and coronary artery disease: A systematic review

OBJECTIVEnIdentify health literacy (HL) screening instruments available to CAD patients; describe the prevalence of low HL; explore the predictors of low HL; and, identify the association between HL, health behaviors, and outcomes among these patients.nnnMETHODSnA literature search of electronic databases was conducted for published articles from database inception to February 2017. Eligible articles included the assessment of HL in CAD patients. Health behaviors and outcomes included diet, exercise, smoking, medication use, hospital readmission, knowledge, health-related quality of life (HRQoL), and psychosocial indicators.nnnRESULTSnOverall, ten articles were included, of which two were RCTs, and seven were considered good quality. The most used screening instruments were REALM and TOFHLA. The average prevalence of low HL was 30.5%. Low HL participants were more likely to be older, male, from a non-white ethnic group, have many CVD comorbidities, lower educational level, disadvantaged socioeconomic position, and less likely to be employed. Low HL was consistently associated with hospital readmissions, low HRQoL, higher anxiety and lower social support.nnnCONCLUSIONnThe literature on HL in CAD patients is very limited.nnnPRACTICE IMPLICATIONSnHealthcare providers should start adopting strategies that can potentially mitigate the impact of low HL in the care of CAD patients.

Effects of comprehensive cardiac rehabilitation on functional capacity and cardiovascular risk factors in Brazilians assisted by public health care: protocol for a randomized controlled trial

ABSTRACT Background Cardiovascular Disease (CVD) is the leading burden of disease worldwide. Moreover, CVD-related death rates are considered an epidemic in low- and middle-income countries (LMICs). Research shows that cardiac rehabilitation (CR) participation reduces death and improves disability and quality of life. Given the growing epidemic of CVD in LMICs and the insufficient evidence about CR programs in these countries, a Randomized Control Trial (RCT) in Latin America is warranted. Objective To investigate the effects of comprehensive CR on functional capacity and cardiovascular risk factors. Method The design is a single-blinded RCT with three parallel arms: comprehensive CR (exercise + education) versus exercise-based CR versus wait-list control (no CR). The primary outcome will be measured by the Incremental Shuttle Walk Test. Secondary outcomes are risk factors (blood pressure, dyslipidemia, dysglycemia, body mass index and waist circumference); tertiary outcomes are heart health behaviors (exercise, medication adherence, diet, and smoking), knowledge, and depressive symptoms. The CR program is six months in duration. Participants randomized to exercise-based CR will receive 24 weeks of exercise classes. The comprehensive CR group will also receive 24 educational sessions, including a workbook. Every outcome will be assessed at baseline and 6-months later, and mortality will be ascertained at six months and one year. Conclusion This will be the first RCT to establish the effects of CR in Latin America. If positive, results will be used to promote broader implementation of comprehensive CR and patient access in the region and to inform a larger-scale trial powered for mortality.

Pulmonary function of children with acute leukemia in maintenance phase of chemotherapy

OBJECTIVE: The aim of this study was to assess the pulmonary function of children with acute leukemia. METHODS: Cross-sectional observational analytical study that enrolled 34 children divided into groups A (17 with acute leukemia in the maintenance phase of chemotherapy) and B (17 healthy children). The groups were matched for sex, age and height. Spirometry was measured using a spirometer Microloop Viasys(r) in accordance with American Thoracic Society and European Respiratory Society guidelines. Maximal respiratory pressures were measured with an MVD300 digital manometer (Globalmed(r)). Maximal inspiratory pressures and maximal expiratory pressures were measured from residual volume and total lung capacity, respectively. RESULTS: Group A showed a significant decrease in maximal inspiratory pressures when compared to group B. No significant difference was found between the spirometric values of the two groups, nor was there any difference between maximal inspiratory pressure and maximal expiratory pressure values in group A compared to the lower limit values proposed as reference. CONCLUSION: Children with acute leukemia, myeloid or lymphoid, during the maintenance phase of chemotherapy exhibited unchanged spirometric variables and maximal expiratory pressure; However, there was a decrease in inspiratory muscle strength.

Comparação das pressões respiratórias máximas entre escolares das redes pública e privada

Objective: To compare the values of maximal inspiratory pressures (MIP) and maximal expiratory pressures (MEP) between students from public and private schools. Methods: Observational cross-sectional study of 144 children from public and private schools. Maximal respiratory pressures were measured with an MVD300 (Globalmed). Student’s t-test was applied to compare average pressures and chi-square test was used to compare the frequency of children who performed or not physical activity. Results: Students from private and public schools showed a mean MIP of 77.0±21.5 and 65.7±18.7cmH 2 O (p=0.002) and MEP of 90.1±22.5 and 79.4±19.0cmH 2 O (p=0.005),OBJETIVO: Comparar los valores obtenidos de las presiones inspiratorias maximas (PImax) y presiones espiratorias maximas (PEmax) entre estudiantes de las redes publica y privada de ensenanza. METODOS: Estudio observacional de tipo descriptivo transversal. Se evaluo a 144 ninos en las dos redes de ensenanza. Las presiones respiratorias maximas fueron medidas con el MVD300 (Gobalmed®). Se aplico la prueba t de Student no pareada para comparar los promedios de las variables y la prueba de chi cuadrado para comparar la frecuencia de ninos que realizaban o no actividad fisica. RESULTADOS: Los alumnos de las escuelas privadas y publicas presentaron, respectivamente, promedio de PImax 77,0±21,5 y 65,7±18,7cmH2O (p=0,002) y PEmax 90,1±22,5 y 79,4±19,0cmH2O (p=0,005). Los muchachos de las escuelas privadas y publicas presentaron promedios de PImax 85,0±20,8 y 74,4±17,1cmH2O (p=0,051) y PEmax 98,5±2,5 y 89,2±16,3cmH2O (p=0,103), respectivamente. Las muchachas de las escuelas privadas y publicas presentaron promedios de PImax 70,0±19,8 y 60,2±17,8cmH2O (p=0,027) y PEmax 82,6±20,0 y 73,2±18,1cmH2O (p=0,035), respectivamente. Un 40% de los alumnos de la red publica y un 95% de los alumnos de la red privada realizaban actividad fisica. Los ninos que realizaban o no actividad fisica presentaron PImax 76,0±20,7 y 63,2±20,0cmH2O (p=0,002) y PEmax 89±21,6 y 77,4±20,5cmH2O (p=0,006), respectivamente. CONCLUSIONES: La fuerza muscular respiratoria de los alumnos de la red privada fue significativamente superior a la de los alumnos de la red publica, especialmente entre las muchachas, y posiblemente esa diferencia este relacionada a la practica de actividad fisica, observada con mas frecuencia en las escuelas privadas.

Corrigendum to “Effects of comprehensive cardiac rehabilitation on functional capacity and cardiovascular risk factors in Brazilians assisted by public health care: Protocol for a randomized controlled trial”

a Departamento de Fisioterapia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil b Cardiovascular Prevention and Rehabilitation Program, University Health Network (UHN), Toronto, ON, Canada c School of Kinesiology and Health Science, York University, Toronto, ON, Canada d Divisão de Cardiologia e Cirurgia Cardiovascular, Hospital Universitário, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil

Validation of a self-administered version of the Mediterranean diet scale (MDS) for cardiac rehabilitation patients in Canada

Abstract The Mediterranean dietary pattern has been linked with lower incidence of cardiovascular disease and the Mediterranean diet scale (MDS) has been created to incorporate and test the inherent characteristics of this dietary pattern. This study aimed to psychometrically validate a self-administered version of the MDS in cardiac rehabilitation (CR) patients in Canada. To establish content validity, the scale was reviewed by an expert interdisciplinary panel. A final version of the tool was tested in 150 CR patients. Cronbach’s alpha was 0.69. All ICC coefficients met the minimum recommended standard. Factor analysis revealed four factors, all internally consistent. Criterion validity was supported by significant differences in total scores by duration in CR. Construct validity was supported by agreements between the self-administered MDS and original MDS in all items and with the 3-day food record in 8 of 13 items. In conclusion, the self-administered version of the MDS demonstrated good reliability and validity.

Effects of comprehensive cardiac rehabilitation on functional capacity in a middle-income country: a randomised controlled trial

Objective Despite the growing epidemic of cardiovascular diseases in middle-income countries, there is insufficient evidence about cardiac rehabilitation (CR) in these countries. Thus, the effects of comprehensive CR on functional capacity and risk factors were investigated in Brazil, to test the hypothesis that it results in better outcomes than exercise-only or no CR. Methods Single-blinded, randomised controlled trial with three parallel arms: comprehensive CR (exercise+education) versus exercise-only CR versus wait-list control. Eligible coronary patients were randomised in blocks of four with 1:1:1 concealed allocation. Participants randomised to exercise-only CR received 36 exercise classes; comprehensive CR group also received 24 educational sessions. The primary outcome was incremental shuttle walk test (ISWT) distance; secondary outcomes were cardiovascular risk factors. All outcomes were assessed at baseline and 6 months later. Analysis of covariance was performed on the basis of intention-to-treat (ITT) and per-protocol. Results 115 (88.5%) patients were randomised; 93 (80.9%) were retained. There were improvements in ISWT distance from pretest to post-test with comprehensive (from 358.4±132.6u2009to 464.8±121.6u2009m; mean change=106.4; p<0.001) and exercise-only (from 391.5±118.8u2009to 488.1±106.3u2009m; mean change=96.5, p<0.001) CR, with significantly greater functional capacity with comprehensive CR versus control (ITT: mean difference=75.6±30.7u2009m, 95% CI 1.4 to 150.2). There were also reductions in systolic blood pressure with comprehensive CR (ITT: reduction of 6.2±17.8u2009mm Hg, p=0.04). There were no significant differences for other outcomes. Conclusion Results showed clinically significant improvements in functional capacity and blood pressure with CR, and significantly greater functional capacity with comprehensive CR compared with usual care. Trial registration number NCT02575976; Results.

Psychosocial well-being over the two years following cardiac rehabilitation initiation & association with heart-health behaviors

OBJECTIVEnTo track psychosocial well-being over 2u202fyears following cardiac rehabilitation (CR) initiation, and its association with heart-health behaviors.nnnMETHODSnPatients from 3 CR programs were approached at their first visit, and consenters completed a survey. Participants were emailed surveys again 6u202fmonths, 1 and 2u202fyears later. Depressive symptoms (PHQ-8) and quality of life were assessed at each point, as were exercise, nutrition, smoking and medication adherence, among other well-being indicators.nnnRESULTSnOf 411 participants, 46.7% were retained at 2u202fyears. Post-CR, there was 70% concordance between participants desired and actual work status. Depressive symptoms were consistently minimal over time (meanu202f=u202f3.17u202f±u202f0.37); Quality of life was high, and increased over time (pu202f=u202f.01). At 2u202fyears, 56.9% participants met exercise recommendations, and 5.4% smoked. With adjustment, greater self-regulation was associated with significantly greater exercise at intake; greater exercise self-efficacy was significantly associated with greater exercise at 1u202fyear; greater disease management self-efficacy was significantly associated with greater exercise at 2u202fyears; greater environmental mastery (actual) was significantly associated with greater exercise at 2u202fyears. Lower depressive symptoms were significantly associated with better nutrition at 2u202fyears.nnnCONCLUSIONnCR initiators are thriving, and this relates to better exercise and diet.

Validation of the Brazilian-Portuguese Version of a Short Questionnaire to Assess Knowledge in Cardiovascular Disease Patients (CADE-Q SV)

Background Patient education is an essential part of cardiovascular patients care targeting self-management behavior to reduce risk factors and subsequent events. Herein, a short and reliable tool to assess patients knowledge in Brazil is warranted. Objectives To translate, culturally-adapt and psychometrically validate the Portuguese version of the Coronary Artery Disease Education Questionnaire Short Version (CADE-Q SV). Methods The Portuguese CADE-Q SV - translated and culturally-adapted - was reviewed by five bilingual experts in cardiovascular disease. This version was then pre-tested in 21 patients, and clarity of items was checked using a Likert-type scale ranging from 1 = not clear to 10 = very clear. It was then psychometrically tested in 200 cardiovascular patients (41%women; mean age = 58.4 ± 11.6 years old). The internal consistency was assessed using Kuder-Richardson-20 (KR-20) and Cronbachs alpha, test-retest reliability through intraclass correlation coefficient (ICC), factor structure using confirmatory factor analysis, and construct validity regarding educational level, family income, and time of diagnosis. Results All questions were considered clear by patients (clarity range:7.8-9.6). KR-20 was 0.70. All ICC values were > 0.70. Factor analysis revealed 6 factors, all internally consistent. Construct validity was supported by significant differences in total scores by educational level and family income (p < 0.001). The overall mean was 13.08 ± 2.61. The area with the highest knowledge was risk factors and the lowest was psychosocial risk. Conclusions The Portuguese CADE-SV was demonstrated to have good validity and reliability. This tool can be applicable in clinical and research settings, assessing cardiovascular patients knowledge as part of an education programming.