The acute myocardial infarction (AMI) present high mortality rate that may be reduced with cardiac rehabilitation. Despite its good establishment in outpatient care, few studies analyzed cardiac ...rehabilitation during hospitalization. Thus, this study aims to clarify the safety and efficacy of early cardiac rehabilitation after AMI. This will be a clinical, controlled, randomized trial with blind outcome evaluation and a superiority hypothesis. Twenty-four patients with AMI will be divided into two groups (1:1 allocation ratio). The intervention group will receive an individualized exercise-based cardiac rehabilitation protocol during hospitalization and a semi-supervised protocol after hospital discharge; the control group will receive conventional care. The primary outcomes will be the cardiac remodeling assessed by cardiac magnetic resonance imaging, functional capacity assessed by maximal oxygen consumption, and cardiac autonomic balance examined via heart rate variability. Secondary outcomes will include safety and the total exercise dose provided during the protocol. Statistical analysis will consider the intent-to-treat analysis. Trial registration. Trial registration number: Brazilian Registry of Clinical Trials (ReBEC) (RBR- 9nyx8hb).
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Pulmonary hypertension (PH) is a complex syndrome characterized by increased pulmonary arterial pressure and classified into five groups, according to dyspnea on exertion and systemic muscle ...dysfunction. These symptoms can be identified using the sit-to-stand test (STS), which indirectly evaluates exercise tolerance and lower limb muscle strength. Previous studies used the STS in PH; however, psychometric properties to understand and validate this test were not described for patients with PH. To evaluate the psychometric properties (validity, reliability, and responsiveness) of different STS protocols in patients with PH. This is a systematic review protocol that will include studies using STS in patients with PH. Searches will be conducted on PubMed/MEDLINE, EMBASE, SciELO, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science databases following PICOT mnemonic strategy and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). Rayyan software will be used for study selection. The Risk of bias will be assessed using the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) tool, while the quality of evidence will be assessed using the modified Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Two researchers will independently conduct the study, and a third researcher will be consulted in case of disagreement. The psychometric properties will be evaluated according to the COSMIN. This protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO, no. CRD42021244271). This systematic review will attempt to identify and show the available evidence on STS for different groups of PH and report validity, reliability, and responsiveness of different protocols.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background
Chronic venous insufficiency (CVI) is a condition related to chronic venous disease that may progress to venous leg ulceration and impair quality of life of those affected. Treatments such ...as physical exercise may be useful to reduce CVI symptoms. This is an update of an earlier Cochrane Review.
Objectives
To evaluate the benefits and harms of physical exercise programmes for the treatment of individuals with non‐ulcerated CVI.
Search methods
The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 28 March 2022.
Selection criteria
We included randomised controlled trials (RCTs) comparing exercise programmes with no exercise in people with non‐ulcerated CVI.
Data collection and analysis
We used standard Cochrane methods. Our primary outcomes were intensity of disease signs and symptoms, ejection fraction, venous refilling time, and incidence of venous leg ulcer. Our secondary outcomes were quality of life, exercise capacity, muscle strength, incidence of surgical intervention, and ankle joint mobility. We used GRADE to assess the certainty of the evidence for each outcome.
Main results
We included five RCTs involving 146 participants. The studies compared a physical exercise group with a control group that did not perform a structured exercise programme. The exercise protocols differed between studies. We assessed three studies to be at an overall unclear risk of bias, one study at overall high risk of bias, and one study at overall low risk of bias. We were not able to combine data in meta‐analysis as studies did not report all outcomes, and different methods were used to measure and report outcomes.
Two studies reported intensity of CVI disease signs and symptoms using a validated scale. There was no clear difference in signs and symptoms between groups in baseline to six months after treatment (Venous Clinical Severity Score mean difference (MD) −0.38, 95% confidence interval (CI) −3.02 to 2.26; 28 participants, 1 study; very low‐certainty evidence), and we are uncertain if exercise alters the intensity of signs and symptoms eight weeks after treatment (MD −4.07, 95% CI −6.53 to −1.61; 21 participants, 1 study; very low‐certainty evidence).
There was no clear difference in ejection fraction between groups from baseline to six months follow‐up (MD 4.88, 95% CI −1.82 to 11.58; 28 participants, 1 study; very low‐certainty evidence).
Three studies reported on venous refilling time. We are uncertain if there is an improvement in venous refilling time between groups for baseline to six‐month changes (MD 10.70 seconds, 95% CI 8.86 to 12.54; 23 participants, 1 study; very low‐certainty evidence) or baseline to eight‐week change (MD 9.15 seconds, 95% CI 5.53 to 12.77 for right side; MD 7.25 seconds, 95% CI 5.23 to 9.27 for left side; 21 participants, 1 study; very low‐certainty evidence). There was no clear difference in venous refilling index for baseline to six‐month changes (MD 0.57 mL/min, 95% CI −0.96 to 2.10; 28 participants, 1 study; very low‐certainty evidence).
No included studies reported the incidence of venous leg ulcers.
One study reported health‐related quality of life using validated instruments (Venous Insufficiency Epidemiological and Economic Study (VEINES) and 36‐item Short Form Health Survey (SF‐36), physical component score (PCS) and mental component score (MCS)). We are uncertain if exercise alters baseline to six‐month changes in health‐related quality of life between groups (VEINES‐QOL: MD 4.60, 95% CI 0.78 to 8.42; SF‐36 PCS: MD 5.40, 95% CI 0.63 to 10.17; SF‐36 MCS: MD 0.40, 95% CI −3.85 to 4.65; 40 participants, 1 study; all very low‐certainty evidence). Another study used the Chronic Venous Disease Quality of Life Questionnaire (CIVIQ‐20), and we are uncertain if exercise alters baseline to eight‐week changes in health‐related quality of life between groups (MD 39.36, 95% CI 30.18 to 48.54; 21 participants, 1 study; very low‐certainty evidence). One study reported no differences between groups without presenting data.
There was no clear difference between groups in exercise capacity measured as time on treadmill (baseline to six‐month changes) (MD −0.53 minutes, 95% CI −5.25 to 4.19; 35 participants, 1 study; very low‐certainty evidence). We are uncertain if exercise improves exercise capacity as assessed by the 6‐minute walking test (MD 77.74 metres, 95% CI 58.93 to 96.55; 21 participants, 1 study; very low‐certainty evidence).
Muscle strength was measured using dynamometry or using heel lifts counts. We are uncertain if exercise increases peak torque/body weight (120 revolutions per minute) (changes from baseline to six months MD 3.10 ft‐lb, 95% CI 0.98 to 5.22; 29 participants, 1 study; very low‐certainty evidence). There was no clear difference between groups in baseline to eight‐week change in strength measured by a hand dynamometer (MD 12.24 lb, 95% CI −7.61 to 32.09 for the right side; MD 11.25, 95% CI −14.10 to 36.60 for the left side; 21 participants, 1 study; very low‐certainty evidence). We are uncertain if there is an increase in heel lifts (n) (baseline to six‐month changes) between groups (MD 7.70, 95% CI 0.94 to 14.46; 39 participants, 1 study; very low‐certainty evidence).
There was no clear difference between groups in ankle mobility measured during dynamometry (baseline to six‐month change MD −1.40 degrees, 95% CI −4.77 to 1.97; 29 participants, 1 study; very low‐certainty evidence). We are uncertain if exercise increases plantar flexion measured by a goniometer (baseline to eight‐week change MD 12.13 degrees, 95% CI 8.28 to 15.98 for right leg; MD 10.95 degrees, 95% CI 7.93 to 13.97 for left leg; 21 participants, 1 study; very low‐certainty evidence). In all cases, we downgraded the certainty of evidence due to risk of bias and imprecision.
Authors' conclusions
There is currently insufficient evidence to assess the benefits and harms of physical exercise in people with chronic venous disease. Future research into the effect of physical exercise should consider types of exercise protocols (intensity, frequency, and time), sample size, blinding, and homogeneity according to the severity of disease.
Background
Chronic venous insufficiency (CVI) is a common disease that causes discomfort and impairs the quality of life of affected persons. Treatments such as physical exercise that aim to increase ...the movement of the ankle joint and strengthen the muscle pump in the calf of the leg may be useful to reduce the symptoms of CVI.
Objectives
To assess and summarise the existing clinical evidence on the efficacy and safety of physical exercise programmes for the treatment of individuals with non‐ulcerated CVI.
Search methods
The Cochrane Vascular Information Specialist (CIS) searched the Cochrane Vascular Specialised Register (May 2016). In addition, the CIS searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 4) and trial databases for details of ongoing or unpublished studies.
Selection criteria
Randomised controlled trials (RCTs) comparing exercise with no exercise programmes.
Data collection and analysis
Two review authors independently assessed the search results and selected eligible studies. We resolved disagreements by discussion. We summarised and double‐checked details from included studies. We attempted to contact trial authors for missing data, but obtained no further information.
Main results
We included two trials involving 54 participants with CVI. Many of our review outcomes were not reported or reported by only one of the two studies. The intensity of disease signs and symptoms was measured in both studies but using different scales; we were therefore unable to pool the data. One study reported no difference between the exercise and control groups whereas the second reported a reduction in symptoms in the exercise group. In one study, increases in change in ejection fraction compared with baseline (mean difference (MD) 4.88%, 95% confidence interval (CI) 3.16 to 6.60; 30 participants; P < 0.00001), half venous refilling time (MD 4.20 seconds, 95% CI 3.28 to 5.12; 23 participants; P < 0.00001) and total venous refilling time (MD 9.40 seconds, 95% CI 7.77 to 11.03; 23 participants; P < 0.00001) were observed in the exercise group compared with the control group. One study reported no difference between the exercise and control groups with regard to quality of life or ankle range of motion. Although muscle strength assessed by dynamometry at slow speed did not differ between the two groups in this study, variable peak torque at fast speed was lower in the control group than in the exercise group (2.8 ± 0.9 compared with ‐0.3 ± 0.6, P < 0.03). The incidence of venous leg ulcers, incidence of surgical intervention to treat symptoms related to CVI and exercise capacity were not assessed or reported in either of the included trials. We rated both included studies as at high risk of bias; hence, these data should be interpreted carefully. Due to the small number of studies and small sample size, we were not able to verify indirectness and publication bias. Therefore, we judged the overall quality of evidence as very low according to the GRADE approach.
Authors' conclusions
There is currently insufficient evidence available to assess the efficacy of physical exercise in people with CVI. Future research into the effect of physical exercise should consider types of exercise protocols (intensity, frequency and time), sample size, blinding and homogeneity according to the severity of disease.
Although the physical therapist profession is the leading established, largely nonpharmacological health profession in the world and is committed to health promotion and noncommunicable disease (NCD) ...prevention, these have yet to be designated as core physical therapist competencies. Based on findings of 3 Physical Therapy Summits on Global Health, addressing NCDs (heart disease, cancer, hypertension, stroke, diabetes, obesity, and chronic lung disease) has been declared an urgent professional priority. The Third Summit established the status of health competencies in physical therapist practice across the 5 World Confederation for Physical Therapy (WCPT) regions with a view to establish health competency standards, this article's focus. Three general principles related to health-focused practice emerged, along with 3 recommendations for its inclusion. Participants acknowledged that specific competencies are needed to ensure that health promotion and NCD prevention are practiced consistently by physical therapists within and across WCPT regions (ie, effective counseling for smoking cessation, basic nutrition, weight control, and reduced sitting and increased activity/exercise in patients and clients, irrespective of their presenting complaints/diagnoses). Minimum accreditable health competency standards within the profession, including use of the WCPT-supported Health Improvement Card, were recommended for inclusion into practice, entry-to-practice education, and research. Such standards are highly consistent with the mission of the WCPT and the World Health Organization. The physical therapist profession needs to assume a leadership role vis-à-vis eliminating the gap between what we know unequivocally about the causes of and contributors to NCDs and the long-term benefits of effective, sustained, nonpharmacological lifestyle behavior change, which no drug nor many surgical procedures have been reported to match.
Cardiopulmonary assessment through oxygen uptake efficiency slope (OUES) data has shown encouraging results, revealing that we can obtain important clinical information about functional status. Until ...now, the use of OUES has not been established as a measure of cardiorespiratory capacity in an obese adult population, only in cardiac and pulmonary diseases or pediatric patients. The aim of this study was to characterize submaximal and maximal levels of OUES in a sample of morbidly obese women and analyze its relationship with traditional measures of cardiorespiratory fitness, anthropometry and pulmonary function. Thirty-three morbidly obese women (age 39.1 ± 9.2 years) performed Cardiopulmonary Exercise Testing (CPX) on a treadmill using the ramp protocol. In addition, anthropometric measurements and pulmonary function were also evaluated. Maximal and submaximal OUES were measured, being calculated from data obtained in the first 50% (OUES50%) and 75% (OUES75%) of total CPX duration. In one-way ANOVA analysis, OUES did not significantly differ between the three different exercise intensities, as observed through a Bland-Altman concordance of 58.9 mL/min/log(L/min) between OUES75% and OUES100%, and 0.49 mL/kg/min/log(l/min) between OUES/kg75% and OUES/kg100%. A strong positive correlation between the maximal (r = 0.79) and submaximal (r = 0.81) OUES/kg with oxygen consumption at peak exercise (VO2peak) and ventilatory anaerobic threshold (VO2VAT) was observed, and a moderate negative correlation with hip circumference (r = -0.46) and body adiposity index (r = -0.50) was also verified. There was no significant difference between maximal and submaximal OUES, showing strong correlations with each other and oxygen consumption (peak and VAT). These results indicate that OUES can be a useful parameter which could be used as a cardiopulmonary fitness index in subjects with severe limitations to perform CPX, as for morbidly obese women.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Breathing exercises for adults with asthma Freitas, Diana A; Holloway, Elizabeth A; Bruno, Selma S ...
Cochrane database of systematic reviews,
10/2013, Letnik:
2013, Številka:
10
Journal Article
Recenzirano
Odprti dostop
Background
Breathing exercises have been widely used worldwide as a complementary therapy to the pharmacological treatment of people with asthma.
Objectives
To evaluate the evidence for the efficacy ...of breathing exercises in the management of patients with asthma.
Search methods
The search for trials led review authors to review the literature available in The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL and AMED and to perform handsearching of respiratory journals and meeting s. Trial registers and reference lists of included articles were also consulted.
The literature search has been updated to January 2013.
Selection criteria
We included randomised controlled trials of breathing exercises in adults with asthma compared with a control group receiving asthma education or, alternatively, with no active control group.
Data collection and analysis
Two review authors independently assessed trial quality and extracted data. RevMan software was used for data analysis based on the fixed‐effect model. Continuous outcomes were expressed as mean differences (MDs) with confidence intervals (CIs) of 95%. Heterogeneity was assessed by inspecting the forest plots. The Chi2 test was applied, with a P value of 0.10 indicating statistical significance. The I2 statistic was implemented, with a value greater than 50% representing a substantial level of heterogeneity.
Main results
A total of 13 studies involving 906 participants are included in the review. The trials were different from one another in terms of type of breathing exercise performed, number of participants enrolled, number and duration of sessions completed, outcomes reported and statistical presentation of data. Asthma severity in participants from the included studies ranged from mild to moderate, and the samples consisted solely of outpatients. The following outcomes were measured: quality of life, asthma symptoms, number of acute exacerbations and lung function. Eleven studies compared breathing exercise with inactive control, and two with asthma education control groups. All eight studies that assessed quality of life reported an improvement in this outcome. An improvement in the number of acute exacerbations was observed by the only study that assessed this outcome. Six of seven included studies showed significant differences favouring breathing exercises for asthma symptoms. Effects on lung function were more variable, with no difference reported in five of the eleven studies that assessed this outcome, while the other six showed a significant difference for this outcome, which favoured breathing exercises. As a result of substantial heterogeneity among the studies, meta‐analysis was possible only for asthma symptoms and changes in the Asthma Quality of Life Questionnaire (AQLQ). Each meta‐analysis included only two studies and showed a significant difference favouring breathing exercises (MD ‐3.22, 95% CI ‐6.31 to ‐0.13 for asthma symptoms; MD 0.79, 95% CI 0.50 to 1.08 for change in AQLQ). Assessment of risk of bias was impaired by incomplete reporting of methodological aspects of most of the included trials.
Authors' conclusions
Even though individual trials reported positive effects of breathing exercises, no reliable conclusions could be drawn concerning the use of breathing exercises for asthma in clinical practice. This was a result of methodological differences among the included studies and poor reporting of methodological aspects in most of the included studies. However, trends for improvement are encouraging, and further studies including full descriptions of treatment methods and outcome measurements are required.
Background
Low cardiopulmonary fitness, measured by oxygen uptake peak (VO
2pk
), is associated with postoperative complications and mortality. Obese people have difficulty in performing the ...cardiopulmonary exercise test, which requires maximal exertion. The incremental shuttle walking test (ISWT) and 6-min walking test (6MWT) have been used to assess cardiorespiratory capacity, mortality, and complications in the postoperative phase. However, the physiological response elicited by these tests in obese people is unknown. This study analyzed and compared cardiopulmonary fitness (oxygen uptake VO
2
and CO
2
output VCO
2
) in the ISWT and 6MWT in obese adults using a telemetry system.
Methods
Fifteen obese patients (10 women; mean age 39.4 ± 10.1 years; mean body mass index 43.5 ± 6.8 kg/m
2
) with normal forced vital capacity (% FVC 93.7) performed the 6MWT and ISWT in the field in this cross-sectional study. Metabolic (VO
2pk
, VCO
2
) and respiratory (minute ventilation; VE) variables were recorded using telemetry.
Results
Obese patients performed the ISWT with an incremental and exponential cardiopulmonary response, with higher VO
2pk
(15.4 ± 2.9 ml/kg/min), VCO
2
(1.7 ± 0.7 l/min), and VE (51.4 ± 21.3 l/min) than the 6MWT (VO
2pk
= 13.2 ± 2.59 ml/kg/min, VCO
2
= 1.4 ± 0.6 l/min; VE = 41.2 ± 16.6 l/min (all
p
< 0.01). They also demonstrated more effort intensity, assessed by VO
2
, (
p
= 0.006) and heart rate (
p
= 0.04) in the ISWT than the 6MWT. In the 6MWT, patients showed a fast rise in ventilatory and metabolic response, reaching a plateau.
Conclusion
The ISWT test generated superior metabolic and ventilatory stress than the 6MWT and may be more suitable for assessing cardiopulmonary fitness than self-paced tests.
Chronic obstructive pulmonary disease (COPD) leads to peripheral and respiratory muscle dysfunctions. Nowadays, inspiratory muscle training can be geared toward strength or endurance gains. This ...study aims to investigate the effects of an inspiratory muscle training (IMT) protocol using different therapeutic modalities to be implemented in pulmonary rehabilitation programs. The effects of IMT on exercise capacity were considered as the primary endpoint, and the effects of IMT on inspiratory muscle function, health-related quality of life, and daily physical activity level were considered as the secondary outcomes.
This study is a blinded-investigator randomized controlled clinical trial. Sixty subjects will be randomly allocated into three groups: (1) pulmonary rehabilitation (PR) associated with inspiratory muscle training without any load (PRWIMT), (2) PR associated with inspiratory muscle training with a linear load (PRIMTLL), and (3) PR associated with inspiratory muscle training with isocapnic voluntary hyperpnea (PRIMTIVH). The protocol will be performed 5 days a week (3 days with supervision) for 10 weeks. The study will assess anthropometric data, lung function, respiratory muscle strength, and functional capacity by the Incremental Shuttle Walking Test and the Six-Minute Walk Test, lung volumes during the submaximal endurance test, peripheral muscle strength of the upper and lower limbs, dyspnea, and quality of life related to health, before and after the training protocol. Normality will be tested using the Kolmogorov-Smirnov test, and variables will be compared by two-way analysis of variance. The significance level was set at p < 0.05. Ethics approval was obtained from the Institutional Ethics Committee in Research (1.663.411). The study results will be disseminated through presentation at specific scientific conferences and publication in peer-reviewed journals.
The different IMT protocols used in our study will be able to guide respiratory therapists to understand and to include in conventional PR programs the most effective respiratory muscle training type in subjects with COPD.
Brazilian Clinical Trials Registry, RBR-94v6kd . Registered on 11 March 2017.
Background
Respiratory function decline has been reported mainly in the morbidly obese. Little is known about the influence of adiposity pattern on the ability to generate strength in respiratory ...muscles. This study evaluated strength and respiratory endurance in the morbidly obese in preoperative bariatric surgery to determine if such variables were affected by different anthropometric markers (body mass index (BMI), waist–hip ratio (WHR), and neck circumference (NC)).
Methods
We evaluated 39 adult and young obese patients of both sexes, with no respiratory or heart diseases. Standard pulmonary function tests and static respiratory muscle strength (maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP)) and endurance (maximum voluntary ventilation (MVV)) were measured in relation to sex and groups (WHR > 0.95 and WHR < 0.95; NC > 43 and NC < 43).
Results
Thirty-nine obese patients (28 women), aged 36.9 + 11.9 years, BMI 49.3 + 5.1 kg/m², WHR 0.96 + 0.07, and NC 44.1 + 4.2 cm, took part in the study Standard pulmonary function tests and respiratory muscle strength were within normal parameters, except MVV (<80%). Obese with NC ≥ 43 cm (
n
= 22) have greater respiratory muscle strength and less endurance, MEP (
p
= 0.031) and MVV (
p
= 0.018). Abdominal adiposity (
n
= 19) does not seem to affect respiratory muscle strength. A positive correlation was observed only between NC and PEF (
r
= 0.392,
p
= 0.014) and marginally between NC and MVV (
r
= 0.308,
p
= 0.056).
Conclusion
Although adiposity patterns did not affect inspiratory muscle strength, neck adiposity was associated lower respiratory muscle endurance.
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