Vanessa Herber

Avaliação da aptidão cardiopulmonar em indivíduos com hemiparesia após acidente vascular encefálico

FUNDAMENTO: Debido a la hemiparesia, la evaluacion de la aptitud cardiorrespiratoria de individuos despues de accidente vascular encefalico (AVE), por medio de pruebas ergometricas con protocolos convencionales, se ha vuelto en un reto. OBJETIVO: Llevar a cabo prueba cardiopulmonar (PCP) en hemipareticos para una evaluacion pre participacion que busca una criteriosa prescripcion de ejercicio aerobico. METODOS: Participaron en el estudio 8 individuos con hemiparesia cronica, que se sometieron a PCP realizado con protocolo individualizado en rampa, desarrollado a partir de la informacion de la velocidad de marcha de los individuos previamente evaluados en prueba de pista. Se considero como la propuesta de inclinacion variando entre el 0% y el 10%, velocidad inicial correspondiente a un 70% del ritmo de caminata confortable y velocidad maxima el 40% superior a la velocidad maxima en la prueba de pista, en la expectativa de que el PCP, con este incremento gradual y constante de la intensidad, durase entre 6 y 8 minutos RESULTADOS: El 100% de los evaluados, la motivacion para la interrupcion de la prueba fue fatiga periferica. El VO2 de pico alcanzado fue de 20,6 ± 5,7 ml/kg.min. Se identifico el Umbral I en todos los examenes, situandose en 82,64 ± 4,78% de la FC de pico y 73,31 ± 4,97% del VO2 de pico. El cociente respiratorio (R) del grupo fue de 0,96 ± 0,09, y tres de los 8 individuos (37,5%) alcanzaron R superior a 1,00, siendo el umbral II identificado en estos sujetos. Se encontraron relaciones positivas entre variables del PCP y scores de equilibrio, desempeno en la prueba de marcha de 6 minutos y velocidad de marcha en el suelo. CONCLUSION: La prueba se revelo util para prescripcion de actividad fisica en estos individuos.BACKGROUND Due to the hemiparesis, the assessment of cardiorespiratory fitness on individuals after cerebrovascular accident (CVA), using exercise tests with conventional protocols, has become a challenge. OBJECTIVE Perform cardiopulmonary test (CPT) in hemiparetic patients to a pre-participation evaluation aimed at a careful prescription of aerobic exercise. METHODS The study included eight individuals with chronic hemiparesis who underwent CPT performed with individualized ramp protocol, developed from information on the gait speed of individuals previously evaluated in the track test. We considered the proposal of inclination ranging from 0 to 10.0%, initial speed corresponding to 70.0% of comfortable walking speed rhythm and 40.0% higher than the maximum speed on the track test, expecting that the CPT with this gradual and steady increase in intensity, lasted from 6 to 8 minutes. RESULTS In 100.0% of the sample, the reason for discontinuation was peripheral fatigue. The peak VO2 achieved was 20.6 ± 5.7 ml/kg.min. The threshold I was identified in all tests, standing at 82.64 ± 4.78% of peak HR and 73.31 ± 4.97% of peak VO2. The respiratory quotient (R) of the group was 0.96 ± 0.09, and three out of eight individuals (37.5%) reached R higher than 1.00, and the Threshold II was identified in these individuals. We found positive relationships between CPT variables and balance scores, performance in the 6-minute walking test and running speed on the ground. CONCLUSION The test proved to be useful for prescribing physical activity in these individuals.

Evaluation of cardiopulmonary fitness in individuals with hemiparesis after cerebrovascular accident.

FUNDAMENTO: Debido a la hemiparesia, la evaluacion de la aptitud cardiorrespiratoria de individuos despues de accidente vascular encefalico (AVE), por medio de pruebas ergometricas con protocolos convencionales, se ha vuelto en un reto. OBJETIVO: Llevar a cabo prueba cardiopulmonar (PCP) en hemipareticos para una evaluacion pre participacion que busca una criteriosa prescripcion de ejercicio aerobico. METODOS: Participaron en el estudio 8 individuos con hemiparesia cronica, que se sometieron a PCP realizado con protocolo individualizado en rampa, desarrollado a partir de la informacion de la velocidad de marcha de los individuos previamente evaluados en prueba de pista. Se considero como la propuesta de inclinacion variando entre el 0% y el 10%, velocidad inicial correspondiente a un 70% del ritmo de caminata confortable y velocidad maxima el 40% superior a la velocidad maxima en la prueba de pista, en la expectativa de que el PCP, con este incremento gradual y constante de la intensidad, durase entre 6 y 8 minutos RESULTADOS: El 100% de los evaluados, la motivacion para la interrupcion de la prueba fue fatiga periferica. El VO2 de pico alcanzado fue de 20,6 ± 5,7 ml/kg.min. Se identifico el Umbral I en todos los examenes, situandose en 82,64 ± 4,78% de la FC de pico y 73,31 ± 4,97% del VO2 de pico. El cociente respiratorio (R) del grupo fue de 0,96 ± 0,09, y tres de los 8 individuos (37,5%) alcanzaron R superior a 1,00, siendo el umbral II identificado en estos sujetos. Se encontraron relaciones positivas entre variables del PCP y scores de equilibrio, desempeno en la prueba de marcha de 6 minutos y velocidad de marcha en el suelo. CONCLUSION: La prueba se revelo util para prescripcion de actividad fisica en estos individuos.BACKGROUND Due to the hemiparesis, the assessment of cardiorespiratory fitness on individuals after cerebrovascular accident (CVA), using exercise tests with conventional protocols, has become a challenge. OBJECTIVE Perform cardiopulmonary test (CPT) in hemiparetic patients to a pre-participation evaluation aimed at a careful prescription of aerobic exercise. METHODS The study included eight individuals with chronic hemiparesis who underwent CPT performed with individualized ramp protocol, developed from information on the gait speed of individuals previously evaluated in the track test. We considered the proposal of inclination ranging from 0 to 10.0%, initial speed corresponding to 70.0% of comfortable walking speed rhythm and 40.0% higher than the maximum speed on the track test, expecting that the CPT with this gradual and steady increase in intensity, lasted from 6 to 8 minutes. RESULTS In 100.0% of the sample, the reason for discontinuation was peripheral fatigue. The peak VO2 achieved was 20.6 ± 5.7 ml/kg.min. The threshold I was identified in all tests, standing at 82.64 ± 4.78% of peak HR and 73.31 ± 4.97% of peak VO2. The respiratory quotient (R) of the group was 0.96 ± 0.09, and three out of eight individuals (37.5%) reached R higher than 1.00, and the Threshold II was identified in these individuals. We found positive relationships between CPT variables and balance scores, performance in the 6-minute walking test and running speed on the ground. CONCLUSION The test proved to be useful for prescribing physical activity in these individuals.

Treinamento de marcha, cardiorrespiratório e muscular após acidente vascular encefálico: estratégias, dosagens e desfechos

INTRODUCTION: An increasing number of training programs with positive results has been proposed for rehabilitation of stroke survivors with motor impairments. However, few studies offer recommendations regarding indications for specific techniques and procedures. OBJECTIVE: To review data from the literature about training and exercise programs in patients with hemiparesis following stroke regarding walking training, lower limb strengthening and cardiorespiratory fitness, and to describe the efficacy, limitations and effect of such programs on cardiovascular, motor recovery and functional status. Method: It was made a search in relevant medical journals for articles of clinical trials, meta-analyses, and literature reviews pertaining to physical training, muscular strengthening, gait training and exercise programs for lower limbs after stroke. RESULTS: It was found 27 articles reporting on various training and exercise techniques (gait training, cardiovascular training, muscle strengthening, and others) and their results on the cardiovascular, musculoskeletal, and neurological systems, as well as functional status in stroke patients. CONCLUSION: Training and exercise programs have value in stroke rehabilitation, and published results are, in general, promising. The differences in the populations tested, methods, and criteria for analysis do not always allow the recommendation of specific procedures in clinical practice.

Relação entre nível de atividade física, equilíbrio e qualidade de vida em indivíduos com hemiparesia

INTRODUCTION: Physical activity brings benefits to the neurological system, especially to motor and balance impairment, which are important deficits in individuals with sequels after a stroke. OBJECTIVE: To assess the correlation between the level of physical activity and balance in the quality of life of individuals with hemiparesis after a stroke. Method: 19 individuals (57.8 ± 14.1 years old) with chronic hemiparesis (44.1 ± 37.9 months) were involved in this study. The study evaluated the human activity profile (HAP), the balance confidence level (ABC), the functional balance (BERG) and quality of life (SSQOL). Data were submitted to analysis of Spearmans correlation coefficient. RESULTS: HAP presented a positive strong correlation with the scores of functional balance (BERG; ρ = 0.73) and a moderated positive correlation with the scores of balance confidence (ABC; ρ = 0.64). Total HAP and the HAP set showed moderate positive correlation with the mobility (respectively ρ = 0.48 and ρ = 0.71), self-care (ρ = 0.48 and ρ = 0.65), upper limb function (ρ = 0.56 for both) and vision (ρ = 0.49 and ρ = 0.69) domains. Quality of life and the family roles and mobility domains showed moderate correlations with both functional and balance with balance confidence. CONCLUSION: The results of this study suggest that the more active the person is, the greater his/her balance and quality of life will be. Considering this, the development of physical activity programs for individuals with hemiparesis after strokes becomes extremely important.

Características espaço-temporais do andar para trás em indivíduos com hemiparesia

The present study aimed to compare spatial temporal variables between forward (FW) and backward walking (BW) in individuals with hemiparesis. Ten adults with chronic hemiparesis (30.6±25.1 months), mild motor impairment (20-31 points on Fugl-Meyer lower limb test), good balance (score=50±7 in the Berg scale) and independent walking (able to walk 10 meters without aid) were videotaped walking at comfortable speed with reflexive markers placed on lateral malleolus. The variables stride length, duration and speed and stance phase duration were analyzed with a two-way ANOVA: task and lower limb (LL). Stride length was lower (~44cm) in BW than in FW (F(1,18)=130,94; p≤0,001), as well as for stride (F(1,18)=163,78;p≤0,001) and walking speed (t19=10,99;p≤0,001). Stride and stance duration were ~0,18s e ~8%, respectively larger in BW than in FW (F(1,18)=11,98; p=0,003; F(1,18)=32,00; p≤0,001, respectively). Although the stride length in BW was reduced, the fact that the affected LL remained longer in stance in BW compared to FW indicates that the BW might be a relevant parameter in motor rehabilitation.

Evaluación de la aptitud cardiopulmonar en individuos con hemiparesia tras accidente vascular encefálico

FUNDAMENTO: Debido a la hemiparesia, la evaluacion de la aptitud cardiorrespiratoria de individuos despues de accidente vascular encefalico (AVE), por medio de pruebas ergometricas con protocolos convencionales, se ha vuelto en un reto. OBJETIVO: Llevar a cabo prueba cardiopulmonar (PCP) en hemipareticos para una evaluacion pre participacion que busca una criteriosa prescripcion de ejercicio aerobico. METODOS: Participaron en el estudio 8 individuos con hemiparesia cronica, que se sometieron a PCP realizado con protocolo individualizado en rampa, desarrollado a partir de la informacion de la velocidad de marcha de los individuos previamente evaluados en prueba de pista. Se considero como la propuesta de inclinacion variando entre el 0% y el 10%, velocidad inicial correspondiente a un 70% del ritmo de caminata confortable y velocidad maxima el 40% superior a la velocidad maxima en la prueba de pista, en la expectativa de que el PCP, con este incremento gradual y constante de la intensidad, durase entre 6 y 8 minutos RESULTADOS: El 100% de los evaluados, la motivacion para la interrupcion de la prueba fue fatiga periferica. El VO2 de pico alcanzado fue de 20,6 ± 5,7 ml/kg.min. Se identifico el Umbral I en todos los examenes, situandose en 82,64 ± 4,78% de la FC de pico y 73,31 ± 4,97% del VO2 de pico. El cociente respiratorio (R) del grupo fue de 0,96 ± 0,09, y tres de los 8 individuos (37,5%) alcanzaron R superior a 1,00, siendo el umbral II identificado en estos sujetos. Se encontraron relaciones positivas entre variables del PCP y scores de equilibrio, desempeno en la prueba de marcha de 6 minutos y velocidad de marcha en el suelo. CONCLUSION: La prueba se revelo util para prescripcion de actividad fisica en estos individuos.BACKGROUND Due to the hemiparesis, the assessment of cardiorespiratory fitness on individuals after cerebrovascular accident (CVA), using exercise tests with conventional protocols, has become a challenge. OBJECTIVE Perform cardiopulmonary test (CPT) in hemiparetic patients to a pre-participation evaluation aimed at a careful prescription of aerobic exercise. METHODS The study included eight individuals with chronic hemiparesis who underwent CPT performed with individualized ramp protocol, developed from information on the gait speed of individuals previously evaluated in the track test. We considered the proposal of inclination ranging from 0 to 10.0%, initial speed corresponding to 70.0% of comfortable walking speed rhythm and 40.0% higher than the maximum speed on the track test, expecting that the CPT with this gradual and steady increase in intensity, lasted from 6 to 8 minutes. RESULTS In 100.0% of the sample, the reason for discontinuation was peripheral fatigue. The peak VO2 achieved was 20.6 ± 5.7 ml/kg.min. The threshold I was identified in all tests, standing at 82.64 ± 4.78% of peak HR and 73.31 ± 4.97% of peak VO2. The respiratory quotient (R) of the group was 0.96 ± 0.09, and three out of eight individuals (37.5%) reached R higher than 1.00, and the Threshold II was identified in these individuals. We found positive relationships between CPT variables and balance scores, performance in the 6-minute walking test and running speed on the ground. CONCLUSION The test proved to be useful for prescribing physical activity in these individuals.