Mariane Borba Monteiro

Comportamento da dor e da função pulmonar em pacientes submetidos à cirurgia cardíaca via esternotomia

Objective: To investigate the pulmonary function and pain in adult patients undergoing heart surgery via sternotomy and to verify possible correlations of these variables with the characteristics of the surgical procedure and hospital stay. Methods: A cross-sectional study was carried out of 70

Effect of exercise performed during hemodialysis: strength versus aerobic.

Rational: Patients under regular dialysis can also present alterations in the cardiovascular, musculoskeletal, and metabolic systems. Objectives: The aim of this study is to compare the effects of strength and aerobic exercises performed during hemodialysis (HD) in individuals with chronic renal disease. Materials and Methods: Randomized clinical trial. It was developed as a program of exercises three times a week, in the first 2 h of HD for 8 weeks. The patients were divided into three groups: control (Group 1, n: 11), strength (Group 2, n: 11), and aerobic (Group 3, n: 10). G1 has not developed any type of physical training; G2 utilized a training load of 40% of one repetition maximum (1RM) with anklets, and developed three series of 15 repetitions. G3 pedaled seated in the dialysis seat, during 20 min, in an ergometric bicycle, with intensity regulated by the perceived effort scale. Before and after 8 weeks, the following variables were evaluated: respiratory muscular strength, pulmonary function, functional capacity, blood biochemistry, and quality of life. Main Findings: In the pre- and post-training comparison, there was statistically significant improvement (p < 0.05) in the maximal inspiratory pressure (MIP), number of steps achieved (NSA), and quality of life (QoL) in the trained groups, as compared to the non-exercised group (G1). Conclusions: The strength and aerobic exercises developed during HD can improve the respiratory muscular strength, functional performance, and quality of life, when compared to individuals presenting the disease who have not developed any type of physical training.

Efeitos do treinamento muscular inspiratório nos pacientes em hemodiálise

INTRODUCTION Chronic kidney disease associated with hemodialysis can have a variety of musculoskeletal complications, in addition to repercussions in pulmonary function. OBJECTIVE To evaluate the effects of inspiratory muscle training on inspiratory muscle strength, pulmonary function, and functional capacity in patients with chronic kidney failure undergoing hemodialysis. METHOD Non-controlled clinical trial, comprising 15 individuals diagnosed with chronic kidney failure and undergoing hemodialysis. Maximum inspiratory (PImax) and expiratory (PEmax) pressures were assessed by use of pressure vacuum meter reading. Pulmonary function was assessed by use of spirometry. Functional capacity was assessed by use of walked distance and oxygen consumption obtained in the six-minute walk test (6MWT). For eight weeks, the inspiratory muscle training (IMT) protocol was applied during hemodialysis sessions, with load set to 40% of PImax and weekly frequency of three alternate days. RESULTS A significant increase in the walked distance was observed after training (455.5 ± 98 versus 557.8 ± 121.0; p = 0.003). No statistically significant difference was observed in the other variables when comparing their pre- and posttraining values. CONCLUSION The study showed no statistically significant difference in respiratory muscle strength, pulmonary function, and oxygen consumption. An increase in the walked distance was observed in the 6MWT.

Avaliação da força muscular respiratória e da função pulmonar em pacientes com insuficiência cardíaca

BACKGROUND: Heart failure (HF) is the inability of the heart to pump enough blood to supply the necessities of the body. Pulmonary function and respiratory muscles can be affected and typical symptoms presented by the patients include discomfort at a minimal exertion. OBJECTIVE: To verify pulmonary function and respiratory muscle strength in patients with class II and III HF as defined by the New York Heart Association (NYHA). METHODS: The study was descriptive and observational, and comprised 12 class II and III HF patients in follow-up at the out-patient. Pulmonary function assessments [Forced Expiratory Volume in the first second (FEV1) and Forced Vital Capacity (FVC)] were performed using microspirometry and respiratory muscle strength [Maximal Expiratory Pressure (MEPmax) and Maximal Inspiratory Pressure (MIPmax)] were evaluated using a pressure transducer (Globalmed™). RESULTS: Differences were found between the functional classes II and III in relation to pulmonary function: FEV1 (II: 91.17±19.87; III: 68.17±21.78); FVC (II: 68.17±21.78; III: 73.67±22.94); and respiratory muscle strength: MIPmax (II: 71.67±40.70; III: 53.33±29.27) and MEPmax (II: 98.83±34.56; III: 58.33±15.06). The class II were higher for all study parameters, only MEPmax revealed a statistically significant difference. CONCLUSION: The pulmonary function and respiratory muscle strength are impaired in heart failure patients class III patients, particularly in relation to MEPmax.

Atendimento fisioterapêutico no pós-operatório imediato de pacientes submetidos à cirurgia abdominal

A series of pulmonary complications can occur after abdominal surgery. Therefore, it is necessary to introduce appropriate treatment early in order to minimize postoperative complications. The objective of the present study was to evaluate patients submitted to abdominal surgery in terms of the effect of physical therapy in the immediate postoperative period. This was a randomized clinical trial, in which one group of patients was submitted to physical therapy in the postoperative recovery room and, subsequently, in the infirmary, whereas another group was submitted to physical therapy in the infirmary exclusively. We conclude that physical therapy performed in the immediate postoperative period minimizes losses in lung function and respiratory muscle strength, as well as shortening recovery room stays.

Efeitos do exercício aeróbio durante a hemodiálise em pacientes com doença renal crônica: uma revisão da literatura

INTRODUCTION Patients with chronic kidney disease (CKD) have reduced physical and functional capacity when compared with the general population. Hemodialysis (HD) restricts patients activities, favoring a sedentary lifestyle and leading to functional limitations. HD patients are less active, present low exercise tolerance and have high physical deconditioning. Physical exercise programs have been proposed as a strategy not only to treat clinical symptoms, but also to reduce physical limitations and improve the quality of life of these patients. OBJECTIVES The purpose of this study was to review the literature on the effects of physical exercise (aerobic exercise on a cycle ergometer for the lower limbs) on CKD undergoing HD. METHODS The Medline, PubMed, Scielo, Embase and DirectScience databases were searched. RESULTS Fourteen randomized controlled clinical trials were analyzed as regards the timing of the intervention during the HD session, exercise intensity and frequency, the duration of the intervention and the main results. CONCLUSION The studies demonstrated that aerobic exercises performed during HD improve the aerobic capacity and physical conditioning, reduce fatigue and anxiety, improve muscle capillarization and resting blood pressure, increase exercise duration and improve urea clearance.

Cytokine response to the 6‐min walk test in individuals with different degrees of COPD

Physical exercise is a key part of rehabilitation programs in chronic obstructive pulmonary disease (COPD) patients, although it could modulates immune system responses by altering the cytokine profile of such individuals. Furthermore, the degree of severity of COPD could influence the inflammatory response induced by exercise. To evaluate the cytokine profile of individuals with different degrees of COPD in response to a 6‐min walk test (6MWT).

Capacidade funcional e força muscular respiratória de candidatos ao transplante hepático

ABSTRACT Introduction: Chronic liver disease results in large functional impact, causing loss of muscle mass and function with consequent reduction of functional capacity. Objective: To evaluate and compare the respiratory muscle strength and functional capacity of candidates for liver transplantation who are under Class B or C according to Child Pugh Score and to correlate these variables within each group. Methods - Cross-sectional study with a convenience sample of 35 patients divided into two groups based on the score obtained in the Child Pugh Score B (19 patients) and Child Pugh Score C (16 patients). All subjects were evaluated in a single moment, and the maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) as well as the distance walked during the 6-minute walk test (6MWT) were measured. Results: Individuals classified with Child Pugh Score B showed higher values in the MIP (- 86.05 vs. 23.89 - 57.94 14.14), p = 0.001, in MEP (84.16 vs. 28.26 72.00 16 1994), p = 0.142, and the distance walked in 6MWT (473.63 vs 376.13 39.00 55.276), p = 0.001. We also found a positive correlation between the values of MIP and distance walked during 6MWT in group B of the Child Pugh Score, r = 0.64 and p = 0.003. Conclusion: The progress of liver disease contributes to the onset of several complications, which together appear to contribute to the reduction of functional capacity of individuals. In our study this was evidenced by the worse performance of Child Pugh score C group. This may suggest that the wait for liver transplantation (LTx) can worsen the functional capacity of these individuals.Keywords: liver disease, functional capacity, respiratory muscle strength, Child-Pugh score.

Correlações entre variáveis respiratórias e funcionais na insuficiência cardíaca

Background: Respiratory alterations can impact on the functional performance of patients with heart failure. Aim: To correlate maximum inspiratory muscular force and lung function variables with functional capacity in heart failure patients. Methods: A transversal study January-July 2007 with 42 chronic heart disease patients (28 males) with no prior pulmonary illness. The patients were in New York Heart Association Functional Class I, II and III. The variables used were maximum inspiratory pressure, forced vital capacity and forced expiratory volume in the first second. Respiratory variables measured were distance covered in the six-minute walk test, NYHA functional class and the physical functioning domain of the Short Form-36 Quality of Life Questionnaire. Results: Maximum inspiratory pressure correlated with the six-minute walk test (r = 0.543 and p < 0.001), functional capacity (r = -0.566 and p < 0.001) and the physical functioning domain score of the Short Form-36 (r = 0.459 and p = 0.002). The same was true of forced vital capacity and the six-minute walk test (r = 0.501 and p = 0.001), functional capacity (r = -0.477 and p = 0.001) and Short Form-36 (r = 0.314 and p = 0.043) variables. Forced expiratory volume correlated with the distance covered in the six-minute walk test (r = 0.514 and p < 0.001) and functional capacity (r = -0.383 and p = 0.012). Conclusion: Lung function and inspiratory muscular force respiratory variables correlated with functional variables in patients with heart failure. Rev Port Pneumol 2009; XV (5): 875-890

A classe da NYHA tem relação com a condição funcional e qualidade de vida na insuficiência cardíaca

A insuficiencia cardiaca (IC) e uma sindrome que se apresenta com crescente prevalencia, podendo limitar o individuo quanto a capacidade fisico-funcional, condicao pulmonar e qualidade de vida. Este estudo tem como objetivo verificar as limitacoes pulmonares e fisicas, bem como a qualidade de vida dos pacientes e compara-las com as classes funcionais da New York Heart Association (NYHA). Estudo transversal, com amostra de 66 pacientes (45 homens). Foram aplicados uma ficha de avaliacao padronizada e o questionario de qualidade de vida Short Form-36 (SF-36). Foram realizados espirometria, manovacuometria e o teste da caminhada de seis minutos (TC6M). Os pacientes (classe I: 24 individuos, classe II: 27 e classe III: 15) possuiam uma media de idade de 57,95±10,96 anos e representaram uma amostra com caracteristicas antropometricas homogeneas. Para a condicao pulmonar, observou-se diferenca estatistica quanto a Capacidade Vital Forcada (CVF), Pico de Fluxo Expiratorio e Pressao Expiratoria Maxima (Pemax). Na distância do TC6M houve diferenca entre classe I e III e entre II e III (classe I: 439,27±58,85 m, classe II: 370,96±74,41 m e classe III: 268,96±83,88 m), com p<0,001. Para o SF-36, houve decrescimo da qualidade de vida conforme o agravo das classes funcionais. Pacientes com IC apresentam diminuicao da condicao pulmonar, capacidade fisico-funcional e qualidade de vida relacionada ao aumento da classe funcional da NYHA.