Patricia Érika de M. Marinho

Knowledge among nephrologists about the importance of exercise in the intradialytic period.

[Purpose] To assess knowledge among nephrologists at hemodialysis services about routine intradialytic therapeutic exercise, in the city of Recife. [Subjects and Methods] A cross-sectional study, consisting of 49 nephrologists working in public and/or private hemodialysis services, who responded to a semi-structured questionnaire about their academic background, medical residency, and knowledge about exercise during the intradialytic period. [Results] About 56.3% practiced for more than 10 years as nephrologists, 69.4% did not receive information about intradialytic physical exercise while in residency, 81.6% considered intradialytic exercise to be important, and 53.0% did not prescribe exercise during hemodialysis. About 61.2% consider the level of physical activity among their patients to be poor. Nephrologists graduating within 2 years were 10 times more likely to prescribe exercise, compared to those with more than 2 years since graduation. [Conclusion] Our study found that the nephrologists interviewed do not usually prescribe intradialytic therapeutic exercise, despite understanding its importance as part of the treatment process. It is necessary to update doctors about the importance of exercise for patients during the intradialytic period, as well as to incorporate this knowledge at the undergraduate level.

Respiratory Muscle Strength, the Six-Minute Walk Test and Quality of Life in Chagas Cardiomyopathy

BACKGROUND AND PURPOSE Patients with heart failure disease develop respiratory and functional limitations and suffer from the negative influence on their quality of life. This study was designed to evaluate respiratory muscle strength and its relationship to functional capacity, quality of life and rate of perceived exertion in patients with Chagas cardiomyopathy. METHODS We evaluated 32 patients divided into groups with and without Chagas heart disease. We measured the Minnesota Living with Heart Failure Questionnaire, the maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), distance walked during the 6-minute walk test, rating of perceived exertion (RPE), heart rate, blood pressure, respiratory rate, oxygen saturation and ejection fraction (EF). RESULTS The group with Chagas heart disease showed decreased quality of life (overall score: p = 0.001; physical domain: p = 0.002; role-emotional domain: p = 0.031 and general health domain: p < 0.001) and MIP (p < 0.001) when compared with the control group. There was no difference between the distance walked in both groups. The RPE was greater in the group with Chagas heart disease (p = 0.001). The MIP correlated with MEP (r = 0.631, p = 0.009) and EF (r = 0.524, p = 0.037). CONCLUSION The inspiratory muscle strength is reduced, and the decreased quality of life has a negative influence on the physical and emotional aspects of the patients with Chagas cardiomyopathy. No correlation was found between perceived exertion and the reduction of respiratory muscle strength.

Effects of daily inspiratory muscle training on respiratory muscle strength and chest wall regional volumes in haemodialysis patients: a randomised clinical trial

Abstract Purpose: Evaluating the effects of interdialytic daily inspiratory muscle training (IMT) on respiratory muscle strength, chest wall regional volumes, diaphragmatic mobility and thickness, pulmonary function, functional capacity, and quality of life (QoL) in haemodialysis (HD) patients. Method: A randomised, and double-blind clinical trial composed of 24 chronic kidney disease patients undergoing HD. Patients were allocated into the IMT group (n = 12) or sham group (n = 12) and performed daily IMT twice per day with a load of 50% inspiratory muscle strength for the IMT group and 5 cmH2O for the sham group during 8 weeks. Respiratory muscle strength, diaphragm thickness and mobility, chest wall regional volumes, functional capacity, and QoL were measured. Results: At the end of the study, an increase in inspiratory and expiratory muscle strength was observed for both groups, but no significant difference was found between them. Changed volume distribution was also observed in the IMT group, with significantly increased inspiratory capacity in the pulmonary compartment compared to the sham group. Conclusions: Daily interdialytic IMT promoted a change in chest wall regional volumes, with an increase in the inspiratory capacity of the pulmonary rib cage. Both groups had increased inspiratory and expiratory muscle strength with daily respiratory exercise.Trial registration: www.ClinicalTrials.gov; study number: NCT02599987; name of trial registry: IMT in Patients with End-stage Renal Disease. Implications for rehabilitation Muscular impairment in chronic kidney disease patients results from a series of common alterations, affecting respiratory muscles. Patients with chronic kidney disease have low values of diaphragmatic thickness. The daily inspiratory muscle training (IMT) or breathing exercise over a period of 8 weeks provided increased respiratory muscle strength. The daily inspiratory muscle training presented a change in tri-compartment distribution of lung volume compared to the sham group, with increased inspiratory capacity of the pulmonary rib cage.

Pulmonary rehabilitation and whole-body vibration in chronic obstructive pulmonary disease

The Whole-Body Vibration (WBV) has been described as an alternative therapeutic resource for patients with Chronic Obstructive Pulmonary Disease (COPD) with similarity to the Pulmonary Rehabilitation Program (PRP). The aim of the study was to compare PRP to WBV on functional capacity and quality of life in patients with COPD. Twenty individuals with COPD were assigned to PRP and WBV, who were evaluated regarding their lung function, functional capacity and quality of life through spirometry, 6-minute walk test (6MWT) and St. George Respiratory Questionnaire (SGRQ), respectively. The main results for the WBV group were, there were improvements in the walked distance on the 6MWT and in the symptoms and total domains of the SGRQ. For the PRP group, we observed improvement in the activity, impact and total domains of SGRQ. We could conclude that the WBV group increased the walked distance in regard to the PRP group and both programs improved the quality of life.

Nível de atividade física e sintomas depressivos em pacientes submetidos à hemodiálise: um estudo de corte transversal

This study aimed to evaluate the association between the presence of depressive symptoms and physical activity level (PAL) in patients with chronic kidney disease undergoing hemodialysis (HD). Cross-sectional study comprising 101 patients on HD, mean age 47.4±12.5 years. Sociodemographic data, economic, clinical, assessment of depressive symptoms (Beck Depression Scale - BDI), PAL (International Physical Activity Questionnaire - IPAQ), guidance for performing physical activity (PA) and time of HD. The prevalence of sedentary and depressive symptoms was 79.2% and 39.6%, respectively. Depressive symptoms were observed in 47.5% of sedentary patients (χ2=10.029, p=0.002), the ratio of prevalence of these symptoms five times higher in this group. 68.3% of patients on HD received no guidance for PA. Under 49 months of hemodialysis treatment, 63.8% of sedentary (χ2=3.011, p=0.083) and 57.5% of patients with depressive symptoms (χ2=0.100, p=0.752) already had these features. Although little is known about the relationship between depression and PA among patients undergoing HD, this study found that depressive symptoms were more prevalent among inactive. The results of this study demonstrate that patients undergoing HD have low PAL, relative presence of depressive symptoms and high lack of guidance on PA.This study aimed to evaluate the association between the presence of depressive symptoms and physical activity level (PAL) in patients with chronic kidney disease undergoing hemodialysis (HD). Cross-sectional study comprising 101 patients on HD, mean age 47.4±12.5 years. Sociodemographic data, economic, clinical, assessment of depressive symptoms (Beck Depression Scale - BDI), PAL (International Physical Activity Questionnaire - IPAQ), guidance for performing physical activity (PA) and time of HD. The prevalence of sedentary and depressive symptoms was 79.2% and 39.6%, respectively. Depressive symptoms were observed in 47.5% of sedentary patients (χ2=10.029, p=0.002), the ratio of prevalence of these symptoms five times higher in this group. 68.3% of patients on HD received no guidance for PA. Under 49 months of hemodialysis treatment, 63.8% of sedentary (χ2=3.011, p=0.083) and 57.5% of patients with depressive symptoms (χ2=0.100, p=0.752) already had these features. Although little is known about the relationship between depression and PA among patients undergoing HD, this study found that depressive symptoms were more prevalent among inactive. The results of this study demonstrate that patients undergoing HD have low PAL, relative presence of depressive symptoms and high lack of guidance on PA.

Nivel de actividad física y síntomas depresivos en pacientes sometidos a hemodiálisis: un estudio de corte transversal

This study aimed to evaluate the association between the presence of depressive symptoms and physical activity level (PAL) in patients with chronic kidney disease undergoing hemodialysis (HD). Cross-sectional study comprising 101 patients on HD, mean age 47.4±12.5 years. Sociodemographic data, economic, clinical, assessment of depressive symptoms (Beck Depression Scale - BDI), PAL (International Physical Activity Questionnaire - IPAQ), guidance for performing physical activity (PA) and time of HD. The prevalence of sedentary and depressive symptoms was 79.2% and 39.6%, respectively. Depressive symptoms were observed in 47.5% of sedentary patients (χ2=10.029, p=0.002), the ratio of prevalence of these symptoms five times higher in this group. 68.3% of patients on HD received no guidance for PA. Under 49 months of hemodialysis treatment, 63.8% of sedentary (χ2=3.011, p=0.083) and 57.5% of patients with depressive symptoms (χ2=0.100, p=0.752) already had these features. Although little is known about the relationship between depression and PA among patients undergoing HD, this study found that depressive symptoms were more prevalent among inactive. The results of this study demonstrate that patients undergoing HD have low PAL, relative presence of depressive symptoms and high lack of guidance on PA.This study aimed to evaluate the association between the presence of depressive symptoms and physical activity level (PAL) in patients with chronic kidney disease undergoing hemodialysis (HD). Cross-sectional study comprising 101 patients on HD, mean age 47.4±12.5 years. Sociodemographic data, economic, clinical, assessment of depressive symptoms (Beck Depression Scale - BDI), PAL (International Physical Activity Questionnaire - IPAQ), guidance for performing physical activity (PA) and time of HD. The prevalence of sedentary and depressive symptoms was 79.2% and 39.6%, respectively. Depressive symptoms were observed in 47.5% of sedentary patients (χ2=10.029, p=0.002), the ratio of prevalence of these symptoms five times higher in this group. 68.3% of patients on HD received no guidance for PA. Under 49 months of hemodialysis treatment, 63.8% of sedentary (χ2=3.011, p=0.083) and 57.5% of patients with depressive symptoms (χ2=0.100, p=0.752) already had these features. Although little is known about the relationship between depression and PA among patients undergoing HD, this study found that depressive symptoms were more prevalent among inactive. The results of this study demonstrate that patients undergoing HD have low PAL, relative presence of depressive symptoms and high lack of guidance on PA.

Physical activity level and depressive symptoms in patients undergoing hemodialysis: a cross-sectional study

This study aimed to evaluate the association between the presence of depressive symptoms and physical activity level (PAL) in patients with chronic kidney disease undergoing hemodialysis (HD). Cross-sectional study comprising 101 patients on HD, mean age 47.4±12.5 years. Sociodemographic data, economic, clinical, assessment of depressive symptoms (Beck Depression Scale - BDI), PAL (International Physical Activity Questionnaire - IPAQ), guidance for performing physical activity (PA) and time of HD. The prevalence of sedentary and depressive symptoms was 79.2% and 39.6%, respectively. Depressive symptoms were observed in 47.5% of sedentary patients (χ2=10.029, p=0.002), the ratio of prevalence of these symptoms five times higher in this group. 68.3% of patients on HD received no guidance for PA. Under 49 months of hemodialysis treatment, 63.8% of sedentary (χ2=3.011, p=0.083) and 57.5% of patients with depressive symptoms (χ2=0.100, p=0.752) already had these features. Although little is known about the relationship between depression and PA among patients undergoing HD, this study found that depressive symptoms were more prevalent among inactive. The results of this study demonstrate that patients undergoing HD have low PAL, relative presence of depressive symptoms and high lack of guidance on PA.This study aimed to evaluate the association between the presence of depressive symptoms and physical activity level (PAL) in patients with chronic kidney disease undergoing hemodialysis (HD). Cross-sectional study comprising 101 patients on HD, mean age 47.4±12.5 years. Sociodemographic data, economic, clinical, assessment of depressive symptoms (Beck Depression Scale - BDI), PAL (International Physical Activity Questionnaire - IPAQ), guidance for performing physical activity (PA) and time of HD. The prevalence of sedentary and depressive symptoms was 79.2% and 39.6%, respectively. Depressive symptoms were observed in 47.5% of sedentary patients (χ2=10.029, p=0.002), the ratio of prevalence of these symptoms five times higher in this group. 68.3% of patients on HD received no guidance for PA. Under 49 months of hemodialysis treatment, 63.8% of sedentary (χ2=3.011, p=0.083) and 57.5% of patients with depressive symptoms (χ2=0.100, p=0.752) already had these features. Although little is known about the relationship between depression and PA among patients undergoing HD, this study found that depressive symptoms were more prevalent among inactive. The results of this study demonstrate that patients undergoing HD have low PAL, relative presence of depressive symptoms and high lack of guidance on PA.

Influência dos corticosteroides inalatórios nas pressões respiratórias máximas de crianças escolares asmáticas

INTRODUCTION: The inhaled corticosteroid (IC) is the mean therapy used for the preventive and maintenance treatment of asthma. Overdose or prolonged use of IC can cause some collateral effects as remission in bone growth, adrenal suppression and myopathy. OBJECTIVES: To evaluate the influence of inhaled corticosteroids in the inspiratory and expiratory strength in asthmatic school children. MATERIALS AND METHODS: A cross-sectional, observational study, that included 60 children between 6 to 12 years divided into three groups: control (CG), asthma (AG) and children whose used IC for at least three months (AG+IC). The maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured in 3 different days with 12 days between them. RESULTS: The mean ± SD of MIP in the third day was - (65.4 ± 21.9), - (74.9 ± 19.5) and - (80.7 ± 21.5) cmH2O to the AG, AG+IC and CG, respectively. The MIP in the AG was lesser than in the CG (p < 0.05). The mean ± SD of MEP in the third day was 52.7 ± 14.8; 61.7 ± 17.4; and 75.6 ± 18.4 cmH2O to the AG, AG+IC and CG, respectively. The MEP was superior in the CG than in the AG (p < 0.05). The MEP was superior in the CG than the AG+CI (p < 0.05). CONCLUSIONS:The results suggest that IC promotes a major control of pulmonary hiperinflation with the increase of MIP in asthmatic children, but decrease the MEP probably by the effect in the type II muscles fibers.