Rêncio Florêncio

Heart Rate Variability at rest and after the 6-minute walk test (6MWT) in children with cystic fibrosis

BACKGROUND Cystic fibrosis (CF) is a multisystem disease that affects the cardiorespiratory system and the cardiac autonomic control may be altered at rest and after a submaximal exercise. OBJECTIVE To assess the cardiac autonomic control by heart rate variability (HRV) analysis before and after a 6-minute walk test (6MWT). METHOD Thirteen children diagnosed with Cystic Fibrosis (CFG) aged 12±2.7 years (FEV1/FVC: 0.83±0.11, FEV1: 71.4±21 %pred) and 12 healthy children (control group-CG) aged 11.4±2.4 years (FEV1/FVC: 0.91±0.12, FEV1: 91.6±17.4 %pred) were included in the study. HRV was evaluated prior to and immediately after the 6MWT and the heart rate recovery assessed on the first and second minute after test. RESULTS Prior to exercise, CF patients presented higher values for the variables LF(nu) (53.2±15.0 vs. 32.8±7.9, p=0.0003) and LF/HF (1.25±0.72 vs. 0.49±0.18, p<0.006) as well as lower values of HF(%) (25.4±18.4 vs. 53±9.6, p=0.002) and HF(nu) (47.3±14.7 vs. 68.3±8.7, p0.001) when compared to CG. After the 6MWT, both groups demonstrated HRV recovery to baseline levels; however, the differences between CFG and CG were maintained for the variables LF(ms 2) (846.7±754.8 vs. 345.6±197.2, p=0.02); LF(%) (35.4±8.1 vs. 25.9±6.2, p=0.002); LF(nu) (60.0±16.3 vs. 34.9±8.7, p<0.0001); HF(%) (27.4±13.7 vs. 48.1±6.3, p=0.0003); HF(nu) (40.4±15.8 vs. 65.6±8.2, p=0.0003) and LF/HF (1.9±1.7 vs. 0.5±0.2, p=0.0001). CONCLUSIONS Children with cystic fibrosis exhibited predominance of sympathetic activity at rest that persisted after the 6-minute walking test when compared to the control group.

Assessment of the acute effects of different PEP levels on respiratory pattern and operational volumes in patients with Parkinson's disease☆

The aim of the study was to determine the acute effects of positive expiratory pressure (PEP) on breathing pattern, operational volumes and shortening velocity of respiratory muscles on patients with Parkinsons disease. It was evaluated 15 patients and healthy controls, by optoelectronic plethysmography, using PEP in three different levels (10, 15 and 20cmH2O). Breathing pattern changed in both groups. Parkinson group increased tidal volume in all PEP levels (p<0.001), but with lower values compared to control. End-inspiratory chest wall volume increased in the Parkinson group at all PEP levels (p<0.001), end-expiratory chest wall volume show a slightly increase when we compared QB to all PEP levels in Parkinsons. There was an intergroup difference in the index of shortening velocity of abdominal, diaphragm and inspiratory muscles of the rib cage at all PEP levels (p<0.01). We conclude that Parkinsons disease promotes important alterations in different breathing pattern components and PEP has significant effects on these alterations.

Observational practice of incentive spirometry in stroke patients

Highlights • Stroke patients performed differently to healthy individuals when learning to use incentive spirometry.• Stroke patients can benefit from learning rehabilitation techniques.• Observational techniques improve the performance of tasks in stroke patients.