Karlyse Claudino Belli

Tai Chi Chuan for Cardiac Rehabilitation in Patients with Coronary Arterial Disease

Background Several studies have shown that Tai Chi Chuan can improve cardiac function in patients with heart disease. Objective To conduct a systematic review of the literature to assess the effects of Tai Chi Chuan on cardiac rehabilitation for patients with coronary artery disease. Methods We performed a search for studies published in English, Portuguese and Spanish in the following databases: MEDLINE, EMBASE, LILACS and Cochrane Register of Controlled Trials. Data were extracted in a standardized manner by three independent investigators, who were responsible for assessing the methodological quality of the manuscripts. Results The initial search found 201 studies that, after review of titles and abstracts, resulted in a selection of 12 manuscripts. They were fully analyzed and of these, nine were excluded. As a final result, three randomized controlled trials remained. The studies analyzed in this systematic review included patients with a confirmed diagnosis of coronary artery disease, all were clinically stable and able to exercise. The three experiments had a control group that practiced structured exercise training or received counseling for exercise. Follow-up ranged from 2 to 12 months. Conclusion Preliminary evidence suggests that Tai Chi Chuan can be an unconventional form of cardiac rehabilitation, being an adjunctive therapy in the treatment of patients with stable coronary artery disease. However, the methodological quality of the included articles and the small sample sizes clearly indicate that new randomized controlled trials are needed in this regard.

Ausência de influência da massa corporal na redução da pressão arterial após exercício físico

BACKGROUND Hypertension (H) is associated with a large number of co-morbidities, including obesity. The correlation between two variables has been investigated. OBJECTIVE To analyze the correlation between the loss of body mass and blood pressure reduction in hypertensive patients undergoing exercising programs (EP). METHODS One hundred eleven hypertensive patients with overweight or obesity were randomly divided into an experimental group (EG). Out of these, 57 (58 +/- 8.9 years old) participated in a three-month EP conducted three times a week in aerobic exercise sessions from 50% to 70% of VO2 peak for 30 to 60 minutes and resistance exercises; and a control group (CG) with 54 (60 +/- 7.7 years old) who did not participate in the EP. In the EG, blood pressure (BP) was measured before each session and the measurement of anthropometric variables (AV) at the beginning of the program and after three months. In the CG the BP and the VA were evaluated in the doctors office at the beginning and at the end of the study. Data were expressed as mean +/- standard deviation (SD). Pearson correlation and t test were used. A value of p < 0.05 was considered significant. RESULTS In the CG there was no significant difference in AV and BP at the beginning and at the end of the study. In the EG, there was no significant alteration in the AV, however, there was blood pressure reduction of 12% in systolic BP (-17.5 mmHg, p = 0.001) and 9% in Diastolic BP (-8.1 mmHg, p = 0. 01) at the end of the study. There was no correlation between the AV and decrease in BP (r = 0.1). CONCLUSION The blood pressure reduction was not correlated with reduction of anthropometric measures after the exercising period.FUNDAMENTO: A hipertensao arterial (HA) e associada com um grande numero de comorbidades, dentre elas, a obesidade. A correlacao entre essas duas variaveis tem sido alvo de investigacao. OBJETIVO: Analisar a correlacao entre a perda de massa corporal e reducao pressorica em hipertensos submetidos a programa de exercicios fisicos (PEF). METODOS: Cento e onze hipertensos com sobrepeso ou obesidade, divididos aleatoriamente em um grupo experimental (GE), com 57 (58 ± 8,9 anos) que participaram de um PEF de tres meses, tres vezes por semana, em sessoes de exercicio aerobio de 50% a 70% do VO2pico, por 30 a 60 minutos, alem de exercicios resistidos; e um grupo controle (GC), com 54 (60 ± 7,7 anos) que nao participaram do PEF. No GE, a pressao arterial (PA) foi aferida antes de cada sessao e a mensuracao das variaveis antropometricas (VA) no inicio do programa e apos tres meses. No GC a PA e as VA foram avaliadas em consultorio medico no inicio e fim do estudo. Os dados foram expressos por media ± desvio padrao (DP), usou-se teste t e correlacao de Pearson. Considerou-se significativo p < 0,05. RESULTADOS: No GC nao ocorreu diferenca significativa nas VA e PA no inicio e fim do estudo. No GE nao ocorreu alteracao significativa nas VA, no entanto, a reducao pressorica de 12% na PA Sistolica (-17,5 mmHg; p = 0,001) e de 9% na PA Diastolica (-8,1 mmHg; p = 0,01) ao final do estudo. Nao houve correlacao entre as VA e queda da PA (r = 0,1). CONCLUSAO: A reducao pressorica nao se correlacionou com reducao das medidas antropometricas apos periodo de exercicio fisico.

Association between Spirituality and Adherence to Management in Outpatients with Heart Failure

Background Spirituality may influence how patients cope with their illness. Objectives We assessed whether spirituality may influence adherence to management of outpatients with heart failure. Methods Cross sectional study enrolling consecutive ambulatory heart failure patients in whom adherence to multidisciplinary treatment was evaluated. Patients were assessed for quality of life, depression, religiosity and spirituality utilizing validated questionnaires. Correlations between adherence and psychosocial variables of interest were obtained. Logistic regression models explored independent predictors of adherence. Results One hundred and thirty patients (age 60 ± 13 years; 67% male) were interviewed. Adequate adherence score was observed in 38.5% of the patients. Neither depression nor religiosity was correlated to adherence, when assessed separately. Interestingly, spirituality, when assessed by both total score sum (r = 0.26; p = 0.003) and by all specific domains, was positively correlated to adherence. Finally, the combination of spirituality, religiosity and personal beliefs was an independent predictor of adherence when adjusted for demographics, clinical characteristics and psychosocial instruments. Conclusion Spirituality, religiosity and personal beliefs were the only variables consistently associated with compliance to medication in a cohort of outpatients with heart failure. Our data suggest that adequately addressing these aspects on patient’s care may lead to an improvement in adherence patterns in the complex heart failure management.

Programa de treinamento em pesquisa: Duke University e Sociedade Brasileira de Cardiologia

BACKGROUND: Research coaching program focuses on the development of abilities and scientific reasoning. For health professionals, it may be useful to increase both the number and quality of projects and manuscripts. OBJECTIVE: To evaluate the initial results and implementation methodology of the Research and Innovation Coaching Program of the Research on Research group of Duke University in the Brazilian Society of Cardiology. METHODS: The program works on two bases: training and coaching. Training is done online and addresses contents on research ideas, literature search, scientific writing and statistics. After training, coaching favors the establishment of a collaboration between researchers and centers by means of a network of contacts. The present study describes the implementation and initial results in reference to the years 2011-2012. RESULTS: In 2011, 24 centers received training, which consisted of online meetings, study and practice of the contents addressed. In January 2012, a new format was implemented with the objective of reaching more researchers. In six months, 52 researchers were allocated. In all, 20 manuscripts were published and 49 more were written and await submission and/or publication. Additionally, five research funding proposals have been elaborated. CONCLUSION: The number of manuscripts and funding proposals achieved the objectives initially proposed. However, the main results of this type of initiative should be measured in the long term, because the consolidation of the national production of high-quality research is a virtuous cycle that feeds itself back and expands over time. (Arq Bras Cardiol 2012;99(6):1075-1081)

Aptidão cardiorrespiratória de uma amostra regional brasileira distribuída em diferentes tabelas

BACKGROUND Most classification tables of cardiorespiratory fitness (CRF) used in clinical practice are international and have not been validated for the Brazilian population. That can result in important discrepancies when that classification is extrapolated to our population. OBJECTIVE To assess the use of major CRF tables available in a Brazilian population sample of the Central High Plan of the state of Rio Grande do Sul (RS). METHODS This study assessed the retrospective data of 2,930 individuals, living in 36 cities of the Central High Plan of the state of RS, and considered the following: presence of risk factors for cardiovascular disease and estimated maximum oxygen consumption (VO2peak) values obtained through exercise test with Bruce protocol. To classify CRF, the individuals were distributed according to sex, inserted in their respective age groups in the Cooper, American Heart Association (AHA) and Universidade Federal de São Paulo (Unifesp) tables, and classified according to their VO2peak. RESULTS Women had lower VO2peak values as compared with those of men (23.5 ± 8.5 vs. 31.7 ± 10.8 mL.kg-1.min-1, p < 0.001). Considering both sexes, VO2peak showed an inverse and moderate correlation with age (R = -0.48, p < 0.001). An important discrepancy in the CRF classification levels was observed between the tables, ranging from 49% (Cooper x AHA) to 75% (Unifesp x AHA). CONCLUSION Our findings indicate important discrepancy in the CRF classification levels of the tables assessed. Future studies could assess whether international tables could be used for the Brazilian population and populations of different regions of Brazil.

Relevance to Home Blood Pressure Monitoring Protocol of Blood Pressure Measurements Taken Before First- Morning Micturition and in the Afternoon

Background The importance of measuring blood pressure before morning micturition and in the afternoon, while working, is yet to be established in relation to the accuracy of home blood pressure monitoring (HBPM). Objective: To compare two HBPM protocols, considering 24-hour ambulatory blood pressure monitoring (wakefulness ABPM) as gold-standard and measurements taken before morning micturition (BM) and in the afternoon (AM), for the best diagnosis of systemic arterial hypertension (SAH), and their association with prognostic markers. Methods After undergoing 24-hour wakefulness ABPM, 158 participants (84 women) were randomized for 3- or 5-day HBPM. Two variations of the 3-day protocol were considered: with measurements taken before morning micturition and in the afternoon (BM+AM); and with post-morning-micturition and evening measurements (PM+EM). All patients underwent echocardiography (for left ventricular hypertrophy - LVH) and urinary albumin measurement (for microalbuminuria - MAU). Result Kappa statistic for the diagnosis of SAH between wakefulness-ABPM and standard 3-day HBPM, 3-day HBPM (BM+AM) and (PM+EM), and 5-day HBPM were 0.660, 0.638, 0.348 and 0.387, respectively. The values of sensitivity of (BM+AM) versus (PM+EM) were 82.6% × 71%, respectively, and of specificity, 84.8% × 74%, respectively. The positive and negative predictive values were 69.1% × 40% and 92.2% × 91.2%, respectively. The comparisons of intraclass correlations for the diagnosis of LVH and MAU between (BM+AM) and (PM+EM) were 0.782 × 0.474 and 0.511 × 0.276, respectively. Conclusions The 3 day-HBPM protocol including measurements taken before morning micturition and during work in the afternoon showed the best agreement with SAH diagnosis and the best association with prognostic markers.

FORÇA MUSCULAR RESPIRATÓRIA DE INDIVÍDUOS COM INSUFICIÊNCIA RENAL CRÔNICA QUE NÃO REALIZAM HEMODIÁLISE

A Insuficiencia Renal Cronica (IRC) e uma sindrome complexa dos rins, acarretando alteracoes em todos os sistemas corporais, na qual os pacientes evoluem com marcada reducao do condicionamento cardiorrespiratorio, alteracoes musculares, reduzida performance fisica e pior qualidade de vida. Este estudo tem como objetivo verificar a forca muscular respiratoria e tambem avaliar outras variaveis, como os aspectos hemodinâmicos e respiratorios em repouso, os fatores de risco para doencas cardiovasculares, medicacao utilizada, dados antropometricos de individuos portadores de Insuficiencia Renal Cronica que nao realizam hemodialise da regiao de Ijui/RS. E um estudo transversal descritivo, do qual participaram 11 individuos, sendo os dados coletados sob os aspectos de fatores de risco para doencas cardiovasculares, medicacao utilizada, dados antropometricos e forca dos musculos respiratorios. Podemos observar que o fator de risco mais prevalente foi a hipertensao arterial sistemica (100%) e o medicamento mais utilizado foi inibidor da enzima conversora da angiotensina (72%). Os individuos apresentaram PImax diminuida (= 70% do previsto), sendo esta menor no genero feminino (p=0,023). Os individuos com IRC que nao fazem hemodialise ja vem apresentando reducao de sua capacidade respiratoria.

Lack of influence of body mass on blood pressure reduction after exercising

BACKGROUND Hypertension (H) is associated with a large number of co-morbidities, including obesity. The correlation between two variables has been investigated. OBJECTIVE To analyze the correlation between the loss of body mass and blood pressure reduction in hypertensive patients undergoing exercising programs (EP). METHODS One hundred eleven hypertensive patients with overweight or obesity were randomly divided into an experimental group (EG). Out of these, 57 (58 +/- 8.9 years old) participated in a three-month EP conducted three times a week in aerobic exercise sessions from 50% to 70% of VO2 peak for 30 to 60 minutes and resistance exercises; and a control group (CG) with 54 (60 +/- 7.7 years old) who did not participate in the EP. In the EG, blood pressure (BP) was measured before each session and the measurement of anthropometric variables (AV) at the beginning of the program and after three months. In the CG the BP and the VA were evaluated in the doctors office at the beginning and at the end of the study. Data were expressed as mean +/- standard deviation (SD). Pearson correlation and t test were used. A value of p < 0.05 was considered significant. RESULTS In the CG there was no significant difference in AV and BP at the beginning and at the end of the study. In the EG, there was no significant alteration in the AV, however, there was blood pressure reduction of 12% in systolic BP (-17.5 mmHg, p = 0.001) and 9% in Diastolic BP (-8.1 mmHg, p = 0. 01) at the end of the study. There was no correlation between the AV and decrease in BP (r = 0.1). CONCLUSION The blood pressure reduction was not correlated with reduction of anthropometric measures after the exercising period.FUNDAMENTO: A hipertensao arterial (HA) e associada com um grande numero de comorbidades, dentre elas, a obesidade. A correlacao entre essas duas variaveis tem sido alvo de investigacao. OBJETIVO: Analisar a correlacao entre a perda de massa corporal e reducao pressorica em hipertensos submetidos a programa de exercicios fisicos (PEF). METODOS: Cento e onze hipertensos com sobrepeso ou obesidade, divididos aleatoriamente em um grupo experimental (GE), com 57 (58 ± 8,9 anos) que participaram de um PEF de tres meses, tres vezes por semana, em sessoes de exercicio aerobio de 50% a 70% do VO2pico, por 30 a 60 minutos, alem de exercicios resistidos; e um grupo controle (GC), com 54 (60 ± 7,7 anos) que nao participaram do PEF. No GE, a pressao arterial (PA) foi aferida antes de cada sessao e a mensuracao das variaveis antropometricas (VA) no inicio do programa e apos tres meses. No GC a PA e as VA foram avaliadas em consultorio medico no inicio e fim do estudo. Os dados foram expressos por media ± desvio padrao (DP), usou-se teste t e correlacao de Pearson. Considerou-se significativo p < 0,05. RESULTADOS: No GC nao ocorreu diferenca significativa nas VA e PA no inicio e fim do estudo. No GE nao ocorreu alteracao significativa nas VA, no entanto, a reducao pressorica de 12% na PA Sistolica (-17,5 mmHg; p = 0,001) e de 9% na PA Diastolica (-8,1 mmHg; p = 0,01) ao final do estudo. Nao houve correlacao entre as VA e queda da PA (r = 0,1). CONCLUSAO: A reducao pressorica nao se correlacionou com reducao das medidas antropometricas apos periodo de exercicio fisico.

Ausencia de influencia de la masa corporal en la reducción de la presión arterial después del ejercicio físico

BACKGROUND Hypertension (H) is associated with a large number of co-morbidities, including obesity. The correlation between two variables has been investigated. OBJECTIVE To analyze the correlation between the loss of body mass and blood pressure reduction in hypertensive patients undergoing exercising programs (EP). METHODS One hundred eleven hypertensive patients with overweight or obesity were randomly divided into an experimental group (EG). Out of these, 57 (58 +/- 8.9 years old) participated in a three-month EP conducted three times a week in aerobic exercise sessions from 50% to 70% of VO2 peak for 30 to 60 minutes and resistance exercises; and a control group (CG) with 54 (60 +/- 7.7 years old) who did not participate in the EP. In the EG, blood pressure (BP) was measured before each session and the measurement of anthropometric variables (AV) at the beginning of the program and after three months. In the CG the BP and the VA were evaluated in the doctors office at the beginning and at the end of the study. Data were expressed as mean +/- standard deviation (SD). Pearson correlation and t test were used. A value of p < 0.05 was considered significant. RESULTS In the CG there was no significant difference in AV and BP at the beginning and at the end of the study. In the EG, there was no significant alteration in the AV, however, there was blood pressure reduction of 12% in systolic BP (-17.5 mmHg, p = 0.001) and 9% in Diastolic BP (-8.1 mmHg, p = 0. 01) at the end of the study. There was no correlation between the AV and decrease in BP (r = 0.1). CONCLUSION The blood pressure reduction was not correlated with reduction of anthropometric measures after the exercising period.FUNDAMENTO: A hipertensao arterial (HA) e associada com um grande numero de comorbidades, dentre elas, a obesidade. A correlacao entre essas duas variaveis tem sido alvo de investigacao. OBJETIVO: Analisar a correlacao entre a perda de massa corporal e reducao pressorica em hipertensos submetidos a programa de exercicios fisicos (PEF). METODOS: Cento e onze hipertensos com sobrepeso ou obesidade, divididos aleatoriamente em um grupo experimental (GE), com 57 (58 ± 8,9 anos) que participaram de um PEF de tres meses, tres vezes por semana, em sessoes de exercicio aerobio de 50% a 70% do VO2pico, por 30 a 60 minutos, alem de exercicios resistidos; e um grupo controle (GC), com 54 (60 ± 7,7 anos) que nao participaram do PEF. No GE, a pressao arterial (PA) foi aferida antes de cada sessao e a mensuracao das variaveis antropometricas (VA) no inicio do programa e apos tres meses. No GC a PA e as VA foram avaliadas em consultorio medico no inicio e fim do estudo. Os dados foram expressos por media ± desvio padrao (DP), usou-se teste t e correlacao de Pearson. Considerou-se significativo p < 0,05. RESULTADOS: No GC nao ocorreu diferenca significativa nas VA e PA no inicio e fim do estudo. No GE nao ocorreu alteracao significativa nas VA, no entanto, a reducao pressorica de 12% na PA Sistolica (-17,5 mmHg; p = 0,001) e de 9% na PA Diastolica (-8,1 mmHg; p = 0,01) ao final do estudo. Nao houve correlacao entre as VA e queda da PA (r = 0,1). CONCLUSAO: A reducao pressorica nao se correlacionou com reducao das medidas antropometricas apos periodo de exercicio fisico.