Maurice Zanini

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.

Tai Chi Chuan improves functional capacity after myocardial infarction: A randomized clinical trial

BACKGROUND Patients with a recent myocardial infarction (MI) present a reduction in functional capacity expressed as a decrease in peak oxygen consumption (Vo2 peak). The impact of a Tai Chi Chuan (TCC) cardiac rehabilitation program for patients recovering from recent MI has yet to be assessed. Our goal is to evaluate functional capacity after a TCC-based cardiac rehabilitation program in patients with recent MI. METHODS A single-blind randomized clinical trial was conducted. The researchers who performed the tests were blinded to group allocation. Between the 14th and 21st days after hospital discharge, all patients performed a cardiopulmonary exercise testing and a laboratory blood workup. Mean age was similar (56±9 years in the TCC group and 60±9 years in the control group). Patients allocated to the intervention group performed 3 weekly sessions of TCC Beijin style for 12 weeks (n=31). The control group participated in 3 weekly sessions of full-body stretching exercises (n=30). RESULTS After the 12-week study period, participants in the TCC group experienced a significant 14% increase in Vo2 peak from baseline (21.6 ± 5.2 to 24.6 ± 5.2 mL/kg per minute), whereas control participants had a nonsignificant 5% decline in Vo2 peak (20.4 ± 5.1 to 19.4 ± 4.4 mL/kg per minute). There was a significant difference between the 2 groups (P<.0001). CONCLUSIONS Tai Chi Chuan practice was associated with an increase in Vo2 peak in patients with a recent MI and may constitute an effective form of cardiac rehabilitation in this patient population.

Alterações na capacidade funcional de pacientes após dois anos da cirurgia de revascularização do miocárdio

OBJECTIVE: To check changes in the functional capacity of patients undergoing coronary artery bypass grafting (CABG) by testing six-minute walk test (6MWT) following two years. METHODS: A prospective cohort study where 215 patients were enrolled who underwent CABG, 13 did not meet the criteria for inclusion. 202 patients were evaluated preoperatively, 13 died during hospitalization and 6 in the follow up of two years. Four patients were considered lost follow up. This study followed 179 patients for two years classified into active and sedentary, according to physical activity in leisure time and to the 6MWT preoperatively and 2 years later. RESULTS: One hundred and twenty patients were evaluated in the day before CABGS, being 67% male with an average age of 63 (± 9.75) years. Before surgery and 2 years later, 52 were active and the 6MWT distances performed had been 359m (± 164.47) and 439m (± 171.34), respectively; P= 0.016. Forty five patients were classified as sedentary before and 2 years after surgery. The 6MWT distances walked before and after surgery had been 255m (± 172.15) and 376m (± 210.92), respectively; P < 0.001. Eighty two patients transited between these two groups, 71 passed from sedentary to active and had walked before and after surgery 289m (± 157.15) and 380m (± 125.44), respectively; P= 0.001. The 11 patients who were active and passed to the sedentary group walked 221m (± 191.91) and 384m (± 63.73), respectively; P= 0.007. CONCLUSION: The functional capacity of the patients submitted to CABGS had a significant improvement in a medium period of follow-up.

Prevalência de dor osteomuscular em profissionais de enfermagem de equipes de cirurgia em um hospital universitário

Dentre as profissoes da area da saude, a enfermagem, em particular, tem sido afetada pelos disturbios musculoesqueleticos produzindo alteracoes na vida desses trabalhadores, impossibilitando-os de realizarem atividades cotidianas e laborais. Objetivo: Investigar a prevalencia de dor osteomuscular e a associacao com a qualidade de vida em profissionais de enfermagem que atuam em equipes de cirurgia no Hospital de Clinicas de Porto Alegre. Metodo: Estudo transversal realizado entre marco de 2011 e janeiro de 2012, em um hospital universitario terciario do sul do Brasil. Foram avaliados 110 trabalhadores de enfermagem das equipes de cirurgia. Foram excluidos os trabalhadores em licenca saude, ferias ou outro tipo de afastamento durante o periodo de coleta dos dados. A dor osteomuscular foi avaliada atraves do questionario Nordico de Sintomas Osteomusculares e a qualidade de vida foi avaliada atraves do questionario Medical Outcomes Study 36 - Item Short-Form Survey (SF-36). As relacoes entre dor osteomuscular e qualidade de vida foram analisadas atraves do Teste U de Mann-Whitney, utilizando nivel de significância de 95%. Resultados: A prevalencia de dor osteomuscular encontrada neste estudo foi de 91,81%. Com relacao as regioes anatomicas, considerou-se as queixas de dor osteomuscular retroativo ha doze meses, onde o predominio foi de dor no pescoco (56%) e ombros (56%). Quando consideramos afastamento por dor osteomuscular encontramos a prevalencia de dor lombar (34%). O grupo que nao relatou dor osteomuscular apresentou melhores indices de qualidade de vida nos dominios de capacidade funcional, aspectos fisicos, dor, vitalidade, aspectos sociais e saude mental. Conclusao: A dor osteomuscular apresenta maior prevalencia nas regioes do pescoco e ombros. Alem disso, o maior numero de afastamentos ocorre por prevalencia de dor lombar entre os trabalhadores de enfermagem das equipes de cirurgia. A dor influenciou na qualidade de vida afetando seis dos dominios avaliados.

Comparação de dois modelos de estratificação de risco em pacientes eletivamente submetidos à cirurgia de revascularização miocárdica

OBJECTIVE: To compare the Cleveland Clinical Score and EuroSCORE when evaluating patients submitted to CABGS electively in Rio Grande do Sul. METHODS: Cohort study with 202 patients submitted to CABGS between January 2006 and March 2007. Surgical risks were categorized by the Cleveland Clinic and EuroSCORE as low, medium and high risks. The incidence of deaths was measured in a 60 days interval. RESULTS: The average age of patients was 62±10 years and 134(66%) were men. A correlation was observed between both scores to classify patients at different levels of risk. Patients were categorized using the Cleveland Clinic and EuroSCORE respectively: 142(70.3%) and 155(76.7%) as low, 56(27.7%) and 43(21,3) as medium and 4(2%) and 4(2%) as high risks, with a Kaplan correlation coefficient of 0.432; p0.001. In the first sixty days after surgery, 13(6.4%) patients had died. A correlation between the higher incidences of death with increased category of risk was observed in the Cleveland Clinic and EuroSCORE. Deaths occurred respectively in the Cleveland and EuroSCORE: 6(4.4%) and 7(4.5%) in the low; 5(8.9%) and 5(11.6%) in the medium and 2(50%) 3 1(25%) in the high risks. Noted sensitivity in surgical mortality forecast was of 72.5% and 66.5% Cleveland and EuroSCORE respectively. CONCLUSION: The Cleveland Clinic and EuroSCORE risk scores have proven effective to evaluate risk of death in patients electively submitted to CABGS.OBJECTIVE To compare the Cleveland Clinical Score and EuroSCORE when evaluating patients submitted to elective CABGS in Rio Grande do Sul, RS, Brazil. METHODS; This was a cohort study of 202 patients given CABGS between January 2006 and March 2007. Surgical risk was categorized according to the Cleveland Clinic Score and the EuroSCORE as low, medium or high. The incidence of deaths was measured over a 60-day period. RESULTS The mean age of patients was 62 ± 10 years and 134 (66%) of them were men. A correlation was observed between the scores for classifying patients into different levels of risk. According to the Cleveland Clinic score and the EuroSCORE, respectively, patients were categorized as follows: 142(70.3%) and 155(76.7%) low risk patients, 56(27.7%) and 43(21.3) intermediate risk patients and 4(2%) and 4(2%) high risk patients; with a Kaplan correlation coefficient of 0.432; p0.001. Thirteen (13, 6.4%) patients died during the first 60 days after surgery. There was a correlation between greater incidence of death and higher risk categories for both the Cleveland Clinic score and the EuroSCORE. Deaths occurred in the Cleveland and EuroSCORE risk groups, respectively, as follows: 6 (4.4%) and 7 (4.5%) in the low risk group; 5 (8.9%) and 5 (11.6%) in the intermediate risk group and 2 (50%) 3 1(25%) in the high risk group. Observed sensitivity for surgical mortality prediction was 72.5% and 66.5% for the Cleveland score and EuroSCORE respectively. CONCLUSION The Cleveland Clinic and EuroSCORE surgical risk prediction instruments are both moderately effective for predicting mortality among elective CABGS patients.

Vasodilation and Reduction of Systolic Blood Pressure after One Session of High-Intensity Interval Training in Patients With Heart Failure with Preserved Ejection Fraction

Background Heart failure with preserved ejection fraction (HFpEF) is a multifactorial syndrome characterized by a limited exercising capacity. High-intensity interval training (HIIT) is an emerging strategy for exercise rehabilitation in different settings. In patients with HFpEF, HIIT subacute effects on endothelial function and blood pressure are still unknown. Objective To evaluate the subacute effect of one HIIT session on endothelial function and blood pressure in patients with HFpEF. Methods Sixteen patients with HFpEF underwent a 36-minute session of HIIT on a treadmill, alternating four minutes of high-intensity intervals with three minutes of active recovery. Brachial artery diameter, flow-mediated dilation, and blood pressure were assessed immediately before and 30 minutes after the HIIT session. In all analyses, p <0.05 was considered statistically significant. Results There was an increase in brachial artery diameter (pre-exercise: 3.96 ± 0.57 mm; post-exercise: 4.33 ± 0.69 mm; p < 0.01) and a decrease in systolic blood pressure (pre-exercise: 138 ± 21 mmHg; post-exercise: 125 ± 20 mmHg; p < 0.01). Flow-mediated dilation (pre-exercise: 5.91 ± 5.20%; post-exercise: 3.55 ± 6.59%; p = 0.162) and diastolic blood pressure (pre-exercise: 81 ± 11 mmHg; post-exercise: 77 ± 8 mmHg; p = 1.000) did not change significantly. There were no adverse events throughout the experiment. Conclusions One single HIIT session promoted an increase in brachial artery diameter and reduction in systolic blood pressure, but it did not change flow-mediated dilation and diastolic blood pressure.