Rafaella Zulianello dos Santos

Desenvolvimento e validação da versão em português da Escala de Barreiras para Reabilitação Cardíaca

BACKGROUND Cardiovascular diseases show high incidence and prevalence in Brazil; however, participation in Cardiac Rehabilitation (CR) is limited and has been poorly investigated in the country. The Cardiac Rehabilitation Barriers Scale (CRBS) was developed to assess the barriers to participation and adherence to CR. OBJECTIVE To translate, cross-culturally adapt and psychometrically validate CRBS to Brazilian Portuguese. METHODS Two independent initial translations were performed. After the reverse translation, both versions were reviewed by a committee. The new version was tested in 173 patients with coronary artery disease (48 women, mean age = 63 years). Of these, 139 (80.3%) participated in CR. Internal consistency was assessed by Cronbachs alpha, test-retest reliability by intraclass correlation coefficient (ICC) and construct validity by factor analysis. T-tests were used to assess criterion validity between participants and non-participants in CR. The applied test results were evaluated regarding patient characteristics (gender, age, health status and educational level). RESULTS The Brazilian Portuguese version of the CRBS had Cronbachs alpha of 0.88, ICC of 0.68 and disclosed five factors, most of which showed to be internally consistent and all were defined by the items. The mean score for patients in CR was 1.29 (SD = 0.27) and 2.36 for ambulatory patients (SD = 0.50) (p <0.001). Criterion validity was also supported by significant differences in total scores by gender, age and educational level. CONCLUSION The Brazilian Portuguese version of CRBS has shown adequate validity and reliability, which supports its use in future studies.

Perceptions of barriers to cardiac rehabilitation use in Brazil

Cardiovascular diseases (CVD) are the leading cause of mortality in middle-income countries, such as Brazil. However, given the diversity in health care systems in Brazil, access to proven services, such as cardiac rehabilitation (CR), varies widely. Purpose To describe and compare multilevel barriers to CR enrollment and participation in three Brazilian cohorts: (1) cardiac outpatients not attending CR (public or private system); (2) cardiac outpatients paying for CR; and (3) residents at high-risk of CVD with access to a free comprehensive exercise program but not making use of the program. Methods Brazilian residents from two cities were invited to participate – Florianopolis, an urban center; and Luzerna, a rural center. Respondents completed a survey including the Cardiac Rehabilitation Barriers Scale. Mann–Whitney U tests were used to compare barriers between cohorts cross-sectionally. Results Six hundred twenty-eight Brazilians consented to participate: 237 (37.7%) from Florianopolis, of which 139 (22.1%) participated in CR; and 391 (62.3%) from Luzerna. The mean total CR barriers for the sample were 1.66 ± 0.6 and differed significantly by cohort (P < 0.001). CR nonattendees from Florianopolis (eg, distance and not knowing about CR) and participants from Luzerna (eg, work and family responsibilities) reported significantly higher barriers than CR attendees from Florianopolis. Conclusion CR nonattendees reported significantly greater barriers than CR attendees. It is hoped that the provision of CR will increase, and that the development of the programs will be in a manner which mitigates the chief barriers identified herein.

Exercício físico controla pressão arterial e melhora qualidade de vida

BACKGROUND: Hypertension can be correctly treated when exercise is regularly practiced and hence, patients would not need anti-hypertensive drugs. PURPOSE: To evaluate the effect of treatment exclusively with exercise on blood pressure (BP) and quality of life (QL) of hypertensive subjects. METHODS: Clinical trial with 32 sedentary hypertensive subjects, aged 55 ± 9 years, under pharmacological treatment (PT) randomly allocated to Exercise Group (EG) and Control Group (CG). At EG, 18 subjects (50% women) at least 10 days after the cessation of PT started the exercise program of 10 weeks, 3x/week, 30 minutes of aerobic exercise followed by resistance exercises, while 14 CG (57% women) remained under PT. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) was evaluated by auscultation at the beginning and end and QL was evaluated using the questionnaire MINICHAL. Data were expressed as mean ± SD and statistical analysis was performed using t test, Mann Whitney U and Wilcoxon tests. RESULTS: At the beginning and end of the study, no significant differences in were observed in BP between groups. Within groups, BP in EG remained similar to the values before drugs were removed (SBP 132.2 ± 13.3 x 134.4 ± 10 mmHg, DBP 85.0 ± 9 x 85.3 ± 10 mmHg p = ns) and the CG (SBP 127.2 ± 19 x 130.2 ± 16 mmHg, DBP 82.1 ± 16 x 85.3 ± 12 mmHg p = ns).For QL, no inter-group difference was observed in scores at the beginning and end; intra-group significant improvement in the emotional aspect of the EG (p = 0.02). CONCLUSION: The anti-hypertensive therapy with exercise only in comparison to conventional pharmacological treatment allowed the same BP control and better QL perception.

HIGH INTENSITY AEROBIC EXERCISE TRAINING INDUCES SIMILAR OR EVEN SUPERIOR BLOOD PRESSURE REDUCING EFFECTS IN CONTROLLED HYPERTENSIVE PATIENTS

Aerobic exercise training is currently used in the nonpharmacologic management of hypertension, however there is controversy on the optimal training intensity that should be recommended. Objective: To compare the effects two exercise training intensities on 24 hour blood pressure monitoring in

Validation of the portuguese version of the tampa scale for kinesiophobia heart (TSK-SV heart)

Introducao: Demonstrou-se que a cinesiofobia tem influencia negativa sobre os resultados da reabilitacao cardiaca e, consequentemente, e importante no contexto clinico. Objetivo: O objetivo deste estudo foi traduzir, fazer a adaptacao cultural e validar em termos psicometricos a Escala de Tampa para Cinesiofobia Cardiaca (TSK-SV Cardiaca) para o portugues do Brasil. Metodos: A versao em portugues foi testada em 300 pacientes em reabilitacao cardiaca. A confiabilidade teste-reteste foi avaliada pelo coeficiente de correlacao intraclasse, a consistencia interna pelo alfa de Cronbach, e a validade de criterio foi avaliada no que diz respeito a educacao dos pacientes, renda, duracao da reabilitacao cardiaca e sexo. Resultados: Apos analise do coeficiente de correlacao intraclasse, um item foi excluido. Todas as quatro areas foram consideradas internamente consistentes (α > 0,7). As diferencas significativas entre os escores totais medios e de renda (p 37). Conclusoes: A versao em portugues do Brasil da TSK-SV Cardiaca demonstrou ter confiabilidade, consistencia e validade suficientes, apoiando a sua utilizacao em estudos futuros.

Validation of a Scale to Assess Patients’ Comprehension of Frequently Used Cardiology Terminology: The Cardiac TERM Scale in Brazilian Portuguese

Purpose The aim of this study was to psychometrically validate the translation of a questionnaire on patient understanding of cardiology terminology (TERM) to Brazilian Portuguese. Design After piloting the translation and cross-cultural adaptation, the 16-item TERM questionnaire was psychometrically tested. Methods Internal and test–retest reliability, as well as validity, were assessed in 322 cardiac patients. Findings Internal (&agr; = .88) and test–retest reliability (all weighted Kappa > 0.63) exceeded the minimum recommended standards. Criterion validity was supported by significant differences in mean scores by socioeconomic indicators (p < .01). Discriminant validity was supported in that cardiac rehabilitation participants had significantly higher TERM scores (p < .001). Participants did not correctly define any of the terms, and a floor effect was identified in all terms. Conclusions The Cardiac TERM Scale was demonstrated to have good reliability and validity. Clinical Relevance The scale can be used by healthcare professionals, such as nurses. Results can be used to inform patient education, which could in turn impact patient adherence to medical advice and hence outcomes.

Development and Psychometric Validation of HIPER-Q to Assess Knowledge of Hypertensive Patients in Cardiac Rehabilitation

Background The absence of instruments capable of measuring the level of knowledge of hypertensive patients in cardiac rehabilitation programs about their disease reflects the lack of specific recommendations for these patients. Objective To develop and validate a questionnaire to evaluate the knowledge of hypertensive patients in cardiac rehabilitation programs about their disease. Methods A total of 184 hypertensive patients (mean age 60.5 ± 10 years, 66.8% men) were evaluated. Reproducibility was assessed by calculation of the intraclass correlation coefficient using the test-retest method. Internal consistency was assessed by the Cronbach’s alpha and the construct validity by the exploratory factorial analysis. Results The final version of the instrument had 17 questions organized in areas considered important for patient education. The instrument proposed showed a clarity index of 8.7 (0.25). The intraclass correlation coefficient was 0.804 and the Cronbach’s correlation coefficient was 0.648. Factor analysis revealed five factors associated with knowledge areas. Regarding the criterion validity, patients with higher education level and higher family income showed greater knowledge about hypertension. Conclusion The instrument has a satisfactory clarity index and adequate validity, and can be used to evaluate the knowledge of hypertensive participants in cardiac rehabilitation programs.

Intense aerobic training promotes reduction of blood pressure in hypertensive

INTRODUCAO: O treinamento fisico promove importantes respostas adaptativas no organismo que diminuem a morbidade e a mortalidade em hipertensos. Entretanto, sao poucos os estudos que avaliaram a resposta pressorica do treinamento aerobio de diferentes intensidades em hipertensos. Objetivo: Analisar os efeitos do treinamento fisico aerobio intenso com relacao ao treinamento fisico moderado sobre a pressao arterial ambulatorial em hipertensos. METODOS: Participaram do estudo 32 hipertensos (48 ± 9 anos) randomizados como: grupo de treinamento aerobio de intensidade moderada (IM), intensidade de 60-65% da frequencia cardiaca de reserva, 40 minutos, tres sessoes por semana (n=12); exercicio aerobio de alta intensidade (AI), intensidade de 80% a 85% da frequencia cardiaca de reserva (n=12), com a duracao ajustada para atingir o mesmo gasto energetico que a IM e um grupo controle (GC) sem exercicios (n=10). Nos tres grupos foram avaliadas variaveis da monitorizacao ambulatorial da pressao arterial de 24 horas (MAPA) antes e apos as oito semanas de intervencao. RESULTADOS: Apos a intervencao a pressao arterial sistolica (PAS) da vigilia reduziu 10,1 mmHg (p=0,024) em AI e 9,7 mmHg (p=0,035) em IM e a pressao arterial diastolica (PAD) da vigilia reduziu 12,3 mmHg (p=0,002) em AI e 8,4 mmHg (p<0,001) em IM. A PAS do sono reduziu 9,5 mmHg (p=0,004) apenas em AI e 9,8 mmHg (p=0,005) em IM. A PAD do sono reduziu 8,2 mmHg (p=0,006) em AI e 4,8 mmHg (p<0,007) em IM. As cargas pressoricas sistolicas e diastolicas da vigilia e do sono reduziram-se significativamente apenas em AI. CONCLUSAO: Treinamento fisico aerobio moderado e intenso com duracao equalizada pelo gasto calorico tem efeito hipotensor semelhante em hipertensos. A carga pressorica reduziu apenas na AI, sendo assim intensidade-dependente.

Entrenamiento aeróbico intenso promueve reducción de la presión arterial en hipertensos

INTRODUCAO: O treinamento fisico promove importantes respostas adaptativas no organismo que diminuem a morbidade e a mortalidade em hipertensos. Entretanto, sao poucos os estudos que avaliaram a resposta pressorica do treinamento aerobio de diferentes intensidades em hipertensos. Objetivo: Analisar os efeitos do treinamento fisico aerobio intenso com relacao ao treinamento fisico moderado sobre a pressao arterial ambulatorial em hipertensos. METODOS: Participaram do estudo 32 hipertensos (48 ± 9 anos) randomizados como: grupo de treinamento aerobio de intensidade moderada (IM), intensidade de 60-65% da frequencia cardiaca de reserva, 40 minutos, tres sessoes por semana (n=12); exercicio aerobio de alta intensidade (AI), intensidade de 80% a 85% da frequencia cardiaca de reserva (n=12), com a duracao ajustada para atingir o mesmo gasto energetico que a IM e um grupo controle (GC) sem exercicios (n=10). Nos tres grupos foram avaliadas variaveis da monitorizacao ambulatorial da pressao arterial de 24 horas (MAPA) antes e apos as oito semanas de intervencao. RESULTADOS: Apos a intervencao a pressao arterial sistolica (PAS) da vigilia reduziu 10,1 mmHg (p=0,024) em AI e 9,7 mmHg (p=0,035) em IM e a pressao arterial diastolica (PAD) da vigilia reduziu 12,3 mmHg (p=0,002) em AI e 8,4 mmHg (p<0,001) em IM. A PAS do sono reduziu 9,5 mmHg (p=0,004) apenas em AI e 9,8 mmHg (p=0,005) em IM. A PAD do sono reduziu 8,2 mmHg (p=0,006) em AI e 4,8 mmHg (p<0,007) em IM. As cargas pressoricas sistolicas e diastolicas da vigilia e do sono reduziram-se significativamente apenas em AI. CONCLUSAO: Treinamento fisico aerobio moderado e intenso com duracao equalizada pelo gasto calorico tem efeito hipotensor semelhante em hipertensos. A carga pressorica reduziu apenas na AI, sendo assim intensidade-dependente.

Treinamento aeróbio intenso promove redução da pressão arterial em hipertensos

INTRODUCAO: O treinamento fisico promove importantes respostas adaptativas no organismo que diminuem a morbidade e a mortalidade em hipertensos. Entretanto, sao poucos os estudos que avaliaram a resposta pressorica do treinamento aerobio de diferentes intensidades em hipertensos. Objetivo: Analisar os efeitos do treinamento fisico aerobio intenso com relacao ao treinamento fisico moderado sobre a pressao arterial ambulatorial em hipertensos. METODOS: Participaram do estudo 32 hipertensos (48 ± 9 anos) randomizados como: grupo de treinamento aerobio de intensidade moderada (IM), intensidade de 60-65% da frequencia cardiaca de reserva, 40 minutos, tres sessoes por semana (n=12); exercicio aerobio de alta intensidade (AI), intensidade de 80% a 85% da frequencia cardiaca de reserva (n=12), com a duracao ajustada para atingir o mesmo gasto energetico que a IM e um grupo controle (GC) sem exercicios (n=10). Nos tres grupos foram avaliadas variaveis da monitorizacao ambulatorial da pressao arterial de 24 horas (MAPA) antes e apos as oito semanas de intervencao. RESULTADOS: Apos a intervencao a pressao arterial sistolica (PAS) da vigilia reduziu 10,1 mmHg (p=0,024) em AI e 9,7 mmHg (p=0,035) em IM e a pressao arterial diastolica (PAD) da vigilia reduziu 12,3 mmHg (p=0,002) em AI e 8,4 mmHg (p<0,001) em IM. A PAS do sono reduziu 9,5 mmHg (p=0,004) apenas em AI e 9,8 mmHg (p=0,005) em IM. A PAD do sono reduziu 8,2 mmHg (p=0,006) em AI e 4,8 mmHg (p<0,007) em IM. As cargas pressoricas sistolicas e diastolicas da vigilia e do sono reduziram-se significativamente apenas em AI. CONCLUSAO: Treinamento fisico aerobio moderado e intenso com duracao equalizada pelo gasto calorico tem efeito hipotensor semelhante em hipertensos. A carga pressorica reduziu apenas na AI, sendo assim intensidade-dependente.