Rodrigo D. M. Plentz

Functional electrical stimulation in the treatment of patients with chronic heart failure: a meta-analysis of randomized controlled trials.

Functional electrical stimulation (FES) produces beneficial effects in the treatment of patients with chronic heart failure (CHF), but studies carried out in these patients show small sample sizes and conflicting results. The aim of this metaanalysis was to systematically review the effect of treatment with FES compared with conventional aerobic exercise training (CA) or control group in patients with CHF. The search strategy included MEDLINE, LILACS, Physiotherapy Evidence Database and Cochrane Library. Randomized trials comparing FES versus CA or control group in the treatment of patients with CHF were included. Two reviewers independently extracted the data. Main analysis used a fixed-effects model. The search retrieved 794 articles, from which seven studies were included. Treatment with FES provided a smaller gain in peak VO2 compared with CA] − 0.74 ml/kg per min [95% confidence interval (CI): − 1.38 to − 0.10]}. There was no difference in the muscle strength [− 0.33Nm (95% CI: − 4.56 to 3.90)] and in the distance of the 6-min walk test [2.73m (95% CI: − 15.39 to 20.85)] on comparing FES with CA. An increase in peak VO2 of 2.78 ml/kg per min (95% CI: 1.44-4.13) was observed in FES versus the control group. Treatment with FES provides a similar gain in the distance of the 6-min walk test and in the muscle strength when compared with CA, but a small gain in the peak VO2. An increase in the peak VO2 can be obtained with FES as compared with the control group. Thus, FES may be an alternative in relation with CA for patients with CHF and with those who are unable to perform this kind of exercise. Eur J Cardiovasc Prev Rehabil 17:254-260

Profile and scientific output analysis of physical therapy researchers with research productivity fellowship from the Brazilian National Council for Scientific and Technological Development

OBJECTIVE To describe the profile and the scientific output of physical therapists researchers holding a research productivity fellowship (PQ) from the Brazilian National Council of Scientific and Technological Development (Conselho Nacional de Desenvolvimento Científico e Tecnológico-CNPq). METHOD This is a cross-sectional study, which has evaluated the Lattes Curriculum of all PQ physiotherapy researchers registered at CNPq holding a research productivity fellowship in the period of 2010. The variables analyzed were: gender, geographic and institutional distribution, duration since doctorate defense, research productivity fellowship level, scientific output until 2010 and the H index in Scopus(®) and ISI databases. RESULTS A total of 55 PQ from the CNPq were identified in the area of knowledge of Physical Therapy and Occupational Therapy, being 81.8% from the Southeast region of Brazil. They were predominantly female (61.8%), with research productivity fellowship level PQ2 (74.5%), and with average time since doctorate defense of 10.1 (±4.1) years. A total of 2.381 articles were published, with average of 42.5 (±18.9) articles/researcher. The average of articles published after doctorate defense was 39.40 (±18.9) articles/researchers with a mean output of 4.2 (±2.0) articles/year. We found 304 articles indexed in the Scopus(®) database with 2.463 citations, and 222 articles indexed in the Web of Science with 1.805 citations. The articles were published in 481 journals, being 244 (50.7%) of them listed on JCR-web. The researchers presented a median 5 of the H index in the Scopus(®) database, and a median 3 in ISI. CONCLUSION The scientific output of the researchers with research productivity fellowship in the field of physical therapy stands out in their indicators, since the figures are very promising for a relatively young area and as it can be observed by the amount of published articles and citations obtained by the national and international research community.

Expiratory and Expiratory Plus Inspiratory Muscle Training Improves Respiratory Muscle Strength in Subjects With COPD: Systematic Review

BACKGROUND: Inspiratory muscle training (IMT) produces beneficial effects in COPD subjects, but the effects of expiratory muscle training (EMT) and EMT plus IMT in ventilatory training are still unclear. The aim of this study was to systematically review the effects of EMT and EMT plus IMT compared to control groups of COPD subjects. METHODS: This study is a systematic review and meta-analysis. The search strategy included MEDLINE, Embase, LILACS, PEDro, and Cochrane CENTRAL and also manual search of references in published studies on the subject. Randomized trials comparing EMT and EMT plus IMT versus control groups of subjects with COPD were included. The outcomes analyzed were respiratory muscle strength and functional capacity. Two reviewers independently extracted the data. RESULTS: The search retrieved 609 articles. Five studies were included. We observed that EMT provided higher gain in maximum expiratory pressure (PEmax 21.49 cm H2O, 95% CI 13.39–29.59) and maximum inspiratory pressure (PImax 7.68 cm H2O, 95% CI 0.90–14.45) compared to control groups. There was no significant difference in the 6-min walk test distance (29.01 m, 95% CI −39.62 to 97.65) and dyspnea (0.15, 95% CI −0.77 to 1.08). In relation to EMT plus IMT, we observed that PEmax (31.98 cm H2O, 95% CI 26.93–37.03) and PImax (27.98 cm H2O, 95% CI 20.10–35.85) presented higher values compared to control groups. CONCLUSIONS: EMT and EMT plus IMT improve respiratory muscle strength and can be used as part of the treatment during pulmonary rehabilitation of subjects with severe to very severe COPD.

VEGF 165 gene therapy for patients with refractory angina: mobilization of endothelial progenitor cells

Background Vascular endothelial growth factor (VEGF) induces mobilization of endothelial progenitor cells (EPCs) with the capacity for proliferation and differentiation into mature endothelial cells, thus contributing to the angiogenic process. Objective We sought to assess the behavior of EPCs in patients with ischemic heart disease and refractory angina who received an intramyocardial injections of 2000 µg of VEGF 165 as the sole therapy. Methods The study was a subanalysis of a clinical trial. Patients with advanced ischemic heart disease and refractory angina were assessed for eligibility. Inclusion criteria were as follows: signs and symptoms of angina and/or heart failure despite maximum medical treatment and a myocardial ischemic area of at least 5% as assessed by single-photon emission computed tomography (SPECT). Exclusion criteria were as follows: age > 65 years, left ventricular ejection fraction < 25%, and a diagnosis of cancer. Patients whose EPC levels were assessed were included. The intervention was 2000 µg of VEGF 165 plasmid injected into the ischemic myocardium. The frequency of CD34+/KDR+ cells was analyzed by flow cytometry before and 3, 9, and 27 days after the intervention. Results A total of 9 patients were included, 8 males, mean age 59.4 years, mean left ventricular ejection fraction of 59.3% and predominant class III angina. The number of EPCs on day 3 was significantly higher than that at baseline (p = 0.03); however, that on days 9th and 27th was comparable to that at baseline. Conclusion We identified a transient mobilization of EPCs, which peaked on the 3th day after VEGF 165 gene therapy in patients with refractory angina and returned to near baseline levels on 9th and 27thdays.

Global Postural Reeducation for patients with musculoskeletal conditions: a systematic review of randomized controlled trials.

ABSTRACT Objectives To systematically review randomized controlled trials that assessed the effects of Global Postural Reeducation (GPR) on patient-reported outcomes in conditions of the musculoskeletal system. Method An electronic search of MEDLINE (via PubMed), EMBASE, Cochrane CENTRAL, and SciELO was performed from their inception to June 2015. Randomized controlled trials that analyzed pain and patient-reported outcomes were included in this review. The Cochrane Collaboration’s Risk of Bias Tool was used to evaluate risk of bias, and the quality of evidence was rated following the GRADE approach. There were no language restrictions. Results Eleven trials were included totaling 383 patients. Overall, the trials had high risk of bias. GPR was superior to no treatment but not to other forms of treatment for pain and disability. No placebo-controlled trials were found. Conclusion GPR is not superior to other treatments; however, it is superior to no treatment. Due to the lack of studies, it is unknown if GPR is better than placebo. The quality of the available evidence ranges from low to very low, therefore future studies may change the effect estimates of GPR in musculoskeletal conditions.

Respiratory training improved ventilatory function and respiratory muscle strength in patients with multiple sclerosis and lateral amyotrophic sclerosis: systematic review and meta-analysis.

BACKGROUND Among neurodegenerative diseases, multiple sclerosis (MS) and amyotrophic lateral sclerosis (ALS) have a high rate of respiratory disability. OBJECTIVES To analyze the effects of respiratory muscle training (RMT) on ventilatory function, muscle strength and functional capacity in patients with MS or ALS. DATA SOURCES A systematic review and meta-analysis of randomized controlled trials (RCTs) was performed. The sources were MEDLINE, PEDro, Cochrane CENTRAL, EMBASE, and LILACS, from inception to January 2015. STUDY SELECTION/ELIGIBILITY CRITERIA The following were included: RCTs of patients with neurodegenerative diseases (MS or lateral ALS) who used the intervention as RMT (inspiratory/expiratory), comparison with controls who had not received RMT full time or were receiving training without load, and evaluations of ventilatory function (forced vital capacity - FVC, forced expiratory volume in one second - FEV1, maximum voluntary ventilation - MVV), respiratory muscle strength (maximal expiratory pressure/maximum inspiratory pressure - MEP/MIP) and functional capacity (6-minute walk test - 6MWT). RESULTS The review included nine papers, and a total of 194 patients. It was observed that RMT significantly increased at MIP (23.50cmH2O; 95% CI: 7.82 to 39.19), MEP (12.03cmH2O; 95% CI: 5.50 to 18.57) and FEV1 (0.27L; 95% CI: 0.12 to 0.42) compared to the control group, but did not differ in FVC (0.48L; 95% CI: -0.15 to 1.10) and distance in 6MWT (17.95m; 95% CI: -4.54 to 40.44). CONCLUSION RMT can be an adjunctive therapy in the rehabilitation of neurodegenerative diseases improving ventilatory function and respiratory strength.

Neurodynamic treatment did not improve pain and disability at two weeks in patients with chronic nerve-related leg pain: a randomised trial

QUESTION In people with nerve-related leg pain, does adding neurodynamic treatment to advice to remain active improve leg pain, disability, low back pain, function, global perceived effect and location of symptoms? DESIGN Randomised trial with concealed allocation and intention-to-treat analysis. PARTICIPANTS Sixty participants with nerve-related leg pain recruited from the community. INTERVENTIONS The experimental group received four sessions of neurodynamic treatment. Both groups received advice to remain active. OUTCOME MEASURES Leg pain and low back pain (0, none, to 10, worst), Oswestry Disability Index (0, none, to 100, worst), Patient-Specific Functional Scale (0, unable to perform, to 30, able to perform), global perceived effect (-5 to 5) and location of symptoms were measured at 2 and 4 weeks after randomisation. Continuous outcomes were analysed by linear mixed models. Location of symptoms was assessed by relative risk (95% CI). RESULTS At 2 weeks, the experimental group did not have significantly greater improvement than the control group in leg pain (MD -1.1, 95% CI -2.3 to 0.1) or disability (MD -3.3, 95% CI -9.6 to 2.9). At 4 weeks, the experimental group experienced a significantly greater reduction in leg pain (MD -2.4, 95% CI -3.6 to -1.2) and low back pain (MD -1.5, 95% CI -2.8 to -0.2). The experimental group also improved significantly more in function at 2 weeks (MD 5.2, 95% CI 2.2 to 8.2) and 4 weeks (MD 4.7, 95% CI 1.7 to 7.8), as well as global perceived effect at 2 weeks (MD 2.5, 95% CI 1.6 to 3.5) and 4 weeks (MD 2.9, 95% CI 1.9 to 3.9). No significant between-group differences occurred in disability at 4 weeks and location of symptoms. CONCLUSION Adding neurodynamic treatment to advice to remain active did not improve leg pain and disability at 2 weeks. TRIAL REGISTRATION NCT01954199. [Ferreira G, Stieven F, Araujo F, Wiebusch M, Rosa C, Plentz R, et al. (2016) Neurodynamic treatment did not improve pain and disability at two weeks in patients with chronic nerve-related leg pain: a randomised trial.Journal of Physiotherapy62: 197-202].

Higher Mean Blood Pressure is Associated With Autonomic Imbalance But Not With Endothelial Dysfunction in Young Soccer Players

BACKGROUND Blood pressure (BP) should be kept within a narrow range to allow adequate tissue perfusion. In particular, heart-rate variability (HRV) can be used to assess autonomic cardiovascular modulation, and flow-mediated dilation (FMD) can provide valuable information about the ability of the cardiovascular system to adapt to different pressures. Our objective in the study described here was to investigate the effect of a difference of 10mm Hg in mean arterial pressure (MAP) on endothelial function and autonomic balance in young and normotensive soccer players. METHODS Twenty-nine young male soccer players (mean age 17.7 years) were divided into two groups according to their MAP (mm Hg): MAP-84 and MAP-94. The BP, FMD, HRV and maximum oxygen uptake (VO2max) of each group were measured. RESULTS Systolic BP (SBP) and diastolic BP (DBP) were significantly higher (P < 0.0001 and P < 0.006, respectively) in the MAP-94 group. There were no differences in VO2max and endothelial function in the two groups (P < 0.7699). However, the standard deviation (SD) of normal RR intervals (SDNN) and the square root of the mean squared differences in successive RR intervals (RMSSD) were significantly lower in the MAP-94 than in the MAP-84 group (P < 0.0001 and P < 0.005, respectively). In the MAP-94 group, both the high-and low-frequency components were significantly (P < 0.001, P < 0.021, P < 0.017, respectively) lower in both absolute and normalized units, whereas the LF/HF ratio was significantly (P < 0.012) higher. CONCLUSIONS Collectively, our findings indicate that in young soccer players, autonomic cardiovascular modulation is impaired when MAP is increased by 10mm Hg, even within an optimal range of BP and regardless of endothelial function and VO2max.

Functional electrical stimulation training on functional capacity and blood pressure variability in a centenarian woman: case study

BACKGROUND Functional electrical stimulation (FES) is a rehabilitation method that can revert alterations provoked by aging, such as reductions in functional capacity and modifications on blood pressure variability (BPV). OBJECTIVES To evaluate the training effects of FES on functional capacity and BPV in a centenarian woman. METHODS A 101-year-old woman without previous disease underwent FES training for 12 weeks, with three 40 min sessions/week. FES was applied at a frequency of 20 Hz with a 0.5 ms pulse, 5 s contraction time, 10 s relaxation time, the maximum tolerable intensity and with progressive overload. Functional capacity was assessed with a six-minute walk test (6MWT) and proximal lower limb strength was assessed with a sit-and-stand test (STST). BPV was measured by continuous recording of pulse pressure and calculated by spectral analysis. All variables were measured before and after FES training. RESULTS After training there was a 70% increase in distance walked in the 6MWT, a 300% increase in the number of STST repetitions, an 8 mmHg reduction in systolic blood pressure (SBP) and a 4 mmHg reduction in diastolic blood pressure (DBP) and mean blood pressure (MBP). Reductions in SBP (11.8 mmHg²), DBP (2.3 mmHg²) and MBP (6.0 mmHg²) variability were also observed. CONCLUSIONS Three months of FES training improved functional capacity and BPV in a centenarian woman.

VEGF gene therapy cooperatively recruits molecules from the immune system and stimulates cell homing and angiogenesis in refractory angina

BACKGROUND New vessels are formed in response to stimuli from angiogenic factors, a process in which paracrine signaling is fundamental. OBJECTIVE To investigate the cooperative paracrine signaling profile in response to Vascular Endothelial Growth Factor (VEGF) gene therapy in patients with coronary artery disease (CAD) and refractory angina. METHOD A cohort study was conducted in which plasma was collected from patients who underwent gene therapy with a plasmid expressing VEGF 165 (10) and from surgical procedure controls (4). Blood samples were collected from both groups prior to baseline and on days 3, 9 and 27 after the interventions and subjected to systemic analysis of protein expression (Interleukin‐6, IL‐6; Tumor Necrosis Factor‐&agr;, TNF‐&agr;; Interleukin‐10, IL‐10; Stromal Derived Factor‐1 &agr;, SDF‐1&agr;; VEGF; Angiopoietin‐1, ANGPT‐1; and Endothelin‐1, ET‐1) using the enzyme‐linked immunosorbent assay (ELISA). RESULTS Analysis showed an increase in proinflammatory IL‐6 (p = 0.02) and ET‐1 (p = 0.05) on day 3 after gene therapy and in VEGF (p = 0.02) on day 9. A strong positive correlation was found between mobilization of endothelial progenitor cells and TNF‐&agr; on day 9 (r = 0.71; p = 0.03). Furthermore, a strong correlation between &bgr;‐blockers, antiplatelets, and vasodilators with SDF‐1&agr; baseline in the group undergoing gene therapy was verified (r = 0.74; p = 0.004). CONCLUSION Analysis of cooperative paracrine signaling after VEGF gene therapy suggests that the immune system cell and angiogenic molecule expression as well as the endothelial progenitor cell mobilization are time‐dependent, influenced by chronic inflammatory process and continuous pharmacological treatment. HIGHLIGHTSVEGF gene therapy is influenced by chronic inflammatory process.Immune system cell and angiogenic expression are time‐dependent by gene therapy.VEGF gene therapy is influenced by continuous pharmacological treatment.Gene therapy provided an angiogenic process at time line.