Vinícius Zacarias Maldaner da Silva

Bone Mineral Density and Respiratory Muscle Strength in Male Individuals with Mental Retardation (with and without Down Syndrome).

The purpose of this study was to assess the respiratory muscle strength (RMS) in individuals with mental retardation (MR), with or without Down Syndrome (DS), and its association with bone mineral density (BMD). Forty-five male individuals (15 with DS, 15 with mental retardation (MR) and 15 apparently healthy controls), aged 20-35, participated in this study. Subject assessment included pulmonary function tests, RMS (maximal inspiratory pressure, MIP, and maximal expiratory pressure, MEP) and BMD of the second and fourth lumbar vertebrae. ANOVA was used to test differences amongst groups. Tukey post hoc test was utilized when significant differences were detected with ANOVA. Bivariate correlation for BMD and respiratory muscle strength was calculated with Pearsons coefficient of correlation. Individuals with MR, both with and without DS, have lower FEV1, FVC, MIP and MEP (p<0.001) compared to controls. Individuals with DS also had lower BMD, which was associated with lower MIP and MEP. Hypotonia, sedentary lifestyle and obesity are factors that may explain lower MIP and MEP in DS. Strategies to increase RMS could decrease the risk of osteoporosis in the DS population.

Noninvasive Ventilation Improves the Cardiovascular Response and Fatigability During Resistance Exercise in Patients With Heart Failure.

PURPOSE: Noninvasive ventilation may improve cardiovascular function and exercise performance. We evaluated the physiologic impact of noninvasive ventilation during isokinetic knee extension resistance exercise in patients with heart failure. METHODS: This clinical trial included 10 male compensated patients with ischemic heart failure (age, 57 ± 9.1 years; ejection fraction, 28.5 ± 5.8%). Subjects underwent 2 bouts of exercise on an isokinetic dynamometer, separated by 72 hours of rest. The resistance exercise was concentric knee extension, at a speed of 60°/s. Five sets of 10 repetitions were performed during the 2 exercise bouts, and each set was separated by 2 minutes of rest. Subjects were administered either bilevel positive airway pressure ventilation (BV) or sham ventilation 20 minutes before and during the 2 exercise sessions in a randomized fashion. Heart rate, systolic blood pressure, and diastolic blood pressure were measured at rest, during exercise, and into recovery. Changes in peak torque (&Dgr;PT), total work (&Dgr;TW), and power (&Dgr;Pw) between the fifth and first sets were also measured. RESULTS: Compared with the sham intervention, BV significantly decreased heart rate, systolic blood pressure, and diastolic blood pressure at rest and during exercise (P < .01). There were no significant differences in these variables during recovery. Bi-level positive airway pressure ventilation also significantly reduced &Dgr;PT, &Dgr;TW, and &Dgr;Pw compared with the sham intervention (P < .01). CONCLUSIONS: Bi-level positive airway pressure ventilation significantly improved the cardiovascular response and fatigability during resistance exercise in patients with heart failure. These results suggest that use of BV during exercise training may be beneficial in this population with chronic disease.

Noninvasive Ventilation in Cardiovascular Rehabilitation

Heart failure patients are functionally limited. Current treatment is based on scientific evidence that has lead to recommendation of a multidisciplinary approach, including exercise intervention for patients with heart failure. Multifactorial pathophysiological abnormalities might limit these patients from performing for adequate time and intensity during exercise training. Noninvasive ventilation can be used as a complementary therapy to improve exercise tolerance and possibly optimize skeletal muscle and cardiopulmonary benefits during cardiovascular rehabilitation.