Paulo Peres

Short-term transcutaneous electrical nerve stimulation after cardiac surgery: effect on pain, pulmonary function and electrical muscle activity

This study aimed to evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) for treatment of postoperative pain in patients who underwent cardiac surgery. In addition, we sought to determine whether TENS would be related to improved pulmonary function and muscle electrical activity in this patient population. Forty-five patients, 32 males and 13 females, aged 41-74 years were randomly allocated to receive TENS (n=23) or sham treatment (n=22) during 4 h on the third postoperative day. A 0-10 visual analogic scale was used to assess pain; lung function was evaluated by spirometry and surface electromyography (n=10 in each group) was used to quantify electrically-induced muscle activity (trapezius and pectoralis major). TENS was associated with significant reductions on spontaneous and cough-induced postoperative pain as compared to sham (P<0.05). There was also improvement in chest wall-pulmonary mechanics after TENS with proportional increases in tidal volume and vital capacity (P<0.05). In addition, electrical activity of both muscle groups was enhanced after TENS, but not post sham (P<0.05). TENS is a valuable strategy to alleviate postoperative pain following cardiac surgery with positive effects on pulmonary ventilatory function and electrical activity of thoracic and girdle muscles.

Diferentes padronizações do teste da caminhada de seis minutos como método para mensuração da capacidade de exercício de idosos com e sem cardiopatia clinicamente evidente

OBJECTIVES Evaluate the correlation between peak oxygen consumption (VO2peak), from cardiopulmonary test with the distance covered in the six-minute walk test (6MWT) in healthy elderly and with myocardial infarction (MI). METHODS Thirty individuals were studied, with age range 65-87 years (76.03 +/- 4.75), divided into 2 groups: Group I--14 with clinically evident coronary heart disease (CHD) and Group II--16 without clinically evident CHD. They were submitted to cardiopulmonary test (CPT) and 2 types of 6MWT, standard test 6MWTs. Variables measure at rest and exertion were heart rate (HR) and respiratory rate (RR), blood pressure (BP), distance covered (DC), and Borgs rate subjective perceived exertion (RPE). RESULTS The study showed significant, strong correlation between distances covered for both 6MWT, and (VO2peak) obtained from cardiopulmonary test (CPT) for all elderly included in the study. When comparing the 6MWT with physiotherapist support (6MWTphy) and without support (6MWTw), statistically significant difference was observed, with higher average values of the DC, of the RH and RR and Borgs RPE in the 6MWTphy, both of the groups. Additionally, the RH reached at final the exertion in 6MWTphy was similar to that obtained in CPT (p<0.05) suggesting that the 6MWT stimulates higher cardiovascular performance. CONCLUSION 6MWTw, adopted a worldwide, by being submaximal imposes lower cardiovascular overburden as compared to 6MWTphy and is probably safer for elderly who are cardiopaths.

Anthropometric and musculoskeletal assessment of patients with Marfan syndrome.

BACKGROUND Marfan syndrome (MS) is an autosomic dominant condition of the connective tissue that involves the ocular, cardiovascular and musculoskeletal systems. MS is caused by mutations in the fibrillin-1 gene, leading to joint ligaments flaccidity, joint hypermobility and an overgrowth of the long bones. OBJECTIVES The aim of the present study was to assess anthropometry, musculoskeletal alterations and the prevalence of physical therapy treatments among patients with MS. METHODS Twenty-six patients were included in this study [17 females (age: 13.23±2.77 years; body mass 51.5±24-68 Kg; height 1.70±1.40-1.81 m; arm span: 1.73±0.12 m) and 9 males (age: 14.44±2.18; body mass: 61.0±42-72 Kg; height: 1.83±1.66-1.97 m; arm span: 1.93±0.13 m)]. Anthropometric measurements and musculoskeletal abnormalities were determined in a standardized fashion: pectus and scoliosis were assessed through radiography and angulation (â) of the scoliosis curve using the Cobb method; arachnodactyly was assessed through the thumb sign and Walker-Murdoch test and dolichostenomelia was assessed by arm span in relation to height. Patients also responded to a questionnaire addressing participation in physical therapy. RESULTS In comparison to values estimated for the Brazilian population, mass and height were greater among the patients with MS (females: p=0.001 e p<0.0005 e males p=0.019 e p=0.0001, respectively). The following musculoskeletal abnormalities were found: pectus in 3 patients (11%), pectus and scoliosis in 19 (73%), dolichostenomelia in 11 (42%) and arachnodactyly in 21 (80%). Eleven patients (42%) with MS had previously undergone physical therapy. CONCLUSIONS Patients with MS exhibit altered musculoskeleto and anthropometry and have infrequent physical therapy treatment.CONTEXTUALIZACAO: A Sindrome de Marfan (SM) e uma doenca autossomica dominante do tecido conjuntivo que envolve os sistemas ocular, cardiovascular e musculoesqueletico, causada por mutacoes no gene da fibrilina1, gerando flacidez nos ligamentos articulares, favorecendo a hipermobilidade articular e reducao na contencao do crescimento osseo. OBJETIVOS: Avaliar as medidas antropometricas, alteracoes musculoesqueleticas e a frequencia do tratamento fisioterapeutico nos pacientes com SM. METODOS: Participaram deste estudo 26 pacientes, sendo 17 do genero feminino, com idade de 13,23±2,77 anos, massa corporea de 51,5±24-68 Kg, altura de 1,70±1,40-1,81 m e envergadura de 1,73±0,12 cm, e nove do genero masculino, com idade de 14,44±2,18, massa corporea de 61,0±42-72 Kg, altura de 1,83±1,66-1,97 m e envergadura de 1,93±0,13. Foram obtidas medidas antropometricas, alteracoes ME de forma padronizada, sendo o pectus e a escoliose, por avaliacao radiologica, e a angulacao (â) da curva escoliotica, pelo metodo de Cobb; a aracnodactilia, pelo sinal do polegar e teste de Walker-Murdoch, e a dolicostenomelia, pela envergadura em relacao a altura. Os pacientes responderam a um questionario quanto a participacao em tratamento de fisioterapia. RESULTADOS: Quando comparados com a estimativa brasileira, a massa corporea e a altura apresentaram valores maiores no genero feminino (p=0,001 e p<0,0005) e masculino (p=0,019 e p=0,0001). Das alteracoes musculoesqueleticas, encontrou-se pectus em 3 (11%), pectus e escoliose em 19 (73%), dolicostenomelia em 11 (42%) e aracnodactilia em 21(80%). Onze (42%) pacientes com SM ja haviam realizado tratamento de fisioterapia. CONCLUSOES: As alteracoes antropometricas e musculoesqueleticas estao presentes na SM, e o tratamento fisioterapeutico e pouco frequente.

Abnormal heart rate recovery and deficient chronotropic response after submaximal exercise in young Marfan syndrome patients.

BACKGROUND Marfan syndrome patients present important cardiac structural changes, ventricular dysfunction, and electrocardiographic changes. An abnormal heart rate response during or after exercise is an independent predictor of mortality and autonomic dysfunction. The aim of the present study was to compare heart rate recovery and chronotropic response obtained by cardiac reserve in patients with Marfan syndrome subjected to submaximal exercise. METHODS A total of 12 patients on β-blocker therapy and 13 off β-blocker therapy were compared with 12 healthy controls. They were subjected to submaximal exercise with lactate measurements. The heart rate recovery was obtained in the first minute of recovery and corrected for cardiac reserve and peak lactate concentration. RESULTS Peak heart rate (141±16 versus 155±17 versus 174±8 bpm; p=0.001), heart rate reserve (58.7±9.4 versus 67.6±14.3 versus 82.6±4.8 bpm; p=0.001), heart rate recovery (22±6 versus 22±8 versus 34±9 bpm; p=0.001), and heart rate recovery/lactate (3±1 versus 3±1 versus 5±1 bpm/mmol/L; p=0.003) were different between Marfan groups and controls, respectively. All the patients with Marfan syndrome had heart rate recovery values below the mean observed in the control group. The absolute values of heart rate recovery were strongly correlated with the heart rate reserve (r=0.76; p=0.001). CONCLUSION Marfan syndrome patients have reduced heart rate recovery and chronotropic deficit after submaximal exercise, and the chronotropic deficit is a strong determinant of heart rate recovery. These changes are suggestive of autonomic dysfunction.

The dysfunction of ammonia in heart failure increases with an increase in the intensity of resistance exercise, even with the use of appropriate drug therapy:

Background: Hyperammonemia during rest periods is a dysfunction in heart failure (HF). The low formation of ammonia during exercise reflects an inefficiency of purine metabolism. Hyperkalemia in response to physical exercise is common in HF and may contribute to a contractile inefficiency in type II fibers, leading to early fatigue. We tested the hypothesis that during resistance exercise of high intensity and low volume, this disorder of ammonia metabolism would be more intense, due to the hyperkalemia present in HF. Methods: Alternating resistance exercise (RE) of low intensity and high volume, and high intensity and low volume, were applied to 18 patients with an interval of 7 days between them (functional class II-III New York Heart Association, FE = 33.5 ± 4%) and compared with 22 healthy controls matched for age and gender. Ammonia, potassium and lactate levels were assessed before and immediately after the RE. Results: Significant differences: Deltas (control vs. HF) in 40% RE: lactate (mg/dl) 26.3 ± 10 vs. 37.7 ± 7; p < 0,001, ammonia (ug/dl) 92.5 ± 18 vs. 48.9 ± 9; p < 0.001. Deltas (control vs. HF) in 80%RE: lactate(mg/dl) 45.0 ± 12 vs. 54.1 ± 11; p < 0.05, ammonia(ug/dl) 133.5 ± 22 vs. 32.2 ± 7; p < 0.001, potassium (mEq/L) 1.6 ± 0.4 vs. 2.0 ± 0.8; p < 0.05. A negative correlation was found between the deltas of ammonia and potassium (r = −0.74, p < 0.001) in the HF group. Conclusions: We conclude that in HF, there is an inefficiency of purine metabolism that increases with increasing exercise intensity, but not with an increase of total volume. These findings suggest that hyperkalemia may play an important role in the disorders of purine metabolism.

Efeito de um programa de exercício físico em portador da Síndrome Marfan com disfunção ventricular

Marfan syndrome (MS) is an autosomal dominant disorder that affects multiple organs and systems. Several cardiac alterations are present, with the main ones being aortic root and ascending aorta dilatation, mitral valve prolapse and left ventricle (LV) dilatation. Aerobic exercise has not shown to be a non-drug therapy that promotes anti-remodeling effect in patients with heart failure. This case report describes the echocardiographic changes in a patient with Marfan syndrome during four years of cardiovascular physical therapy.El Sindrome de Marfan (SM) es un desorden autosomico dominante que afecta multiples organos y sistemas. Diversas alteraciones cardiacas estan presentes, siendo las principales la dilatacion de la raiz de la aorta y de la aorta ascendente, el Prolapso de Valvula Mitral y la dilatacion del Ventriculo Izquierdo (VI). El ejercicio aerobico ha mostrado ser un recurso terapeutico no medicamentoso, por promover efecto de antirremodelado en pacientes con insuficiencia cardiaca. Este relato de caso describe las alteraciones ecocardiograficas de un paciente con Sindrome de Marfan durante cuatro anos de un programa de fisioterapia cardiovascular.

Effect of a physical exercise program in a patient with Marfan Syndrome and ventricular dysfunction

Marfan syndrome (MS) is an autosomal dominant disorder that affects multiple organs and systems. Several cardiac alterations are present, with the main ones being aortic root and ascending aorta dilatation, mitral valve prolapse and left ventricle (LV) dilatation. Aerobic exercise has not shown to be a non-drug therapy that promotes anti-remodeling effect in patients with heart failure. This case report describes the echocardiographic changes in a patient with Marfan syndrome during four years of cardiovascular physical therapy.El Sindrome de Marfan (SM) es un desorden autosomico dominante que afecta multiples organos y sistemas. Diversas alteraciones cardiacas estan presentes, siendo las principales la dilatacion de la raiz de la aorta y de la aorta ascendente, el Prolapso de Valvula Mitral y la dilatacion del Ventriculo Izquierdo (VI). El ejercicio aerobico ha mostrado ser un recurso terapeutico no medicamentoso, por promover efecto de antirremodelado en pacientes con insuficiencia cardiaca. Este relato de caso describe las alteraciones ecocardiograficas de un paciente con Sindrome de Marfan durante cuatro anos de un programa de fisioterapia cardiovascular.

Efecto de un programa de ejercicio físico en portador del Síndrome Marfan con disfunción ventricular

Marfan syndrome (MS) is an autosomal dominant disorder that affects multiple organs and systems. Several cardiac alterations are present, with the main ones being aortic root and ascending aorta dilatation, mitral valve prolapse and left ventricle (LV) dilatation. Aerobic exercise has not shown to be a non-drug therapy that promotes anti-remodeling effect in patients with heart failure. This case report describes the echocardiographic changes in a patient with Marfan syndrome during four years of cardiovascular physical therapy.El Sindrome de Marfan (SM) es un desorden autosomico dominante que afecta multiples organos y sistemas. Diversas alteraciones cardiacas estan presentes, siendo las principales la dilatacion de la raiz de la aorta y de la aorta ascendente, el Prolapso de Valvula Mitral y la dilatacion del Ventriculo Izquierdo (VI). El ejercicio aerobico ha mostrado ser un recurso terapeutico no medicamentoso, por promover efecto de antirremodelado en pacientes con insuficiencia cardiaca. Este relato de caso describe las alteraciones ecocardiograficas de un paciente con Sindrome de Marfan durante cuatro anos de un programa de fisioterapia cardiovascular.