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- ItemAcesso aberto (Open Access)Associação entre maturação sexual e limiar de lactato em meninas de 10-15 anos(Universidade Federal de São Paulo (UNIFESP), 2010-08-25) Nicoláo, Ana Lúcia Anauate [UNIFESP]; Barros Neto, Turibio Leite de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The lactate thresholds are used to assess the aerobic capacity in different ages. Studies show that children and adolescents present less lactate blood concentrations [la] than adults under certain effort loads. There are evidences that this is related to their maturational development. Objective: To verify the association between the sexual maturation and the lactate threshold in some adolescent soccer players ranging from 12 to 15 years old. Method: The sample was related to the intentional and not probabilistic type involving 36 girls, from 12 to 15 years old, members of the soccer schools held by the Mayority of São Paulo. The body weight, height and the sum of two skinfolds – calf and triceps were obtained from the sample. A physician directly observed the sexual maturation of the genitals and pubic hair development through the Tanner index. To determine the lactate threshold a progressive test, a 3 x 800 m in running track, was performed by adolescents, their effort intensity was controlled by pre-established heart rate zones and the [la] were measured at the end of each run. The velocity corresponding to [la] of 2,5 mmol.L-1 (V2,5) was obtained through the linear interpolation. The multiple linear regression was used to better understand the nature of these associations between the variables, considering the lactate threshold (V2,5) as a dependent variable and the age (years), the body weight index (kg/m2), height (cm) and the sum of the skinfolds (mm) as independent variables. Result: The growth variables and the sexual maturation have little association with the lactate threshold in the youngest and pre-adolescent girls. It is important to take in consideration the sexual maturation influence on the threshold lactate. Conclusion: Taking in account the group homogeneity and being the range between 12 and 15 years old a period susceptible to many modifications, the maturational development and not the chronological age showed to be responsible for a significant difference in the analyzed variables.
- ItemAcesso aberto (Open Access)Athlete's heart in a Brazilian paralympic judo team. Case series study(Associacao Paulista Medicina, 2018) Oliveira Filho, Japy Angelini [UNIFESP]; Barros, Maria Beatriz Monteiro [UNIFESP]; Salles, Ana Fatima [UNIFESP]; Echenique, Leandro Santini [UNIFESP]; Campos Filho, Orlando [UNIFESP]; Póvoa, Rui Manuel dos Santos [UNIFESP]BACKGROUND: Athlete's heart is a term describing the cardiovascular effects of long-term conditioning among highly trained athletes. It is a variation of normal standards. DESIGN AND SETTING: Case series study at the cardiology division of a public university hospital. METHODS: We studied 14 visually handicapped paralympic athletes (8 men) in the national judo team. They were 26.3 +/- 6.4 years old, with body mass index 25 +/- 14, and had been practicing judo for 9.2 +/- 7.9 years. Clinical evaluations, electrocardiograms, exercise testing and echocardiograms were performed by independent observers. RESULTS: Signs of athlete's heart were found in all athletes, comprising left ventricular hypertrophy (5 cases), sinus bradycardia (5), T-wave juvenile pattern (3), T wave juvenile pattern (3), left atrial hypertrophy (2) and increased left ventricular volume (9 cases
- ItemAcesso aberto (Open Access)Avaliação da capacidade de exercício em portadores de doença pulmonar obstrutiva crônica: comparação do teste de caminhada com carga progressiva com o teste de caminhada com acompanhamento(Sociedade Brasileira de Pneumologia e Tisiologia, 2006-04-01) Rosa, Fernanda Warken [UNIFESP]; Camelier, Aquiles Assunção [UNIFESP]; Mayer, Anamaria [UNIFESP]; Jardim, José Roberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To evaluate the applicability of the incremental (shuttle) walk test in patients with chronic obstructive pulmonary disease and compare the performance of those patients on the shuttle walk test to that of the same patients on the encouraged 6-minute walk test. METHODS: A cross-sectional study was conducted, in which 24 patients with chronic obstructive pulmonary disease were selected. In random order, patients were, after an initial practice period, submitted to a shuttle walk test and an encouraged 6-minute walk test. RESULTS: The patients obtained a higher heart rate (expressed as a percentage of that predicted based on gender and age) on the encouraged 6-minute walk test (84.1 ± 11.4%) than on the shuttle walk test (76.4 ± 9.7%) (p = 0.003). The post-test sensation of dyspnea (Borg scale) was also higher on the encouraged 6-minute walk test. On average, the patients walked 307.0 ± 89.3 meters on the shuttle walk test and 515.5 ± 102.3 meters on the encouraged 6-minute walk test (p < 0.001). There was a good correlation between the two tests in terms of the distance walked (r = 0.80, p < 0.001). CONCLUSION: The shuttle walk test is simple and easy to implement in patients with chronic obstructive pulmonary disease. The encouraged 6-minute walk test produced higher post-test heart rate and greater post-test sensation of dyspnea than did the shuttle walk test.
- ItemSomente MetadadadosCan bronchodilators improve exercise tolerance in COPD patients without dynamic hyperinflation?(Soc Brasileira Pneumologia Tisiologia, 2014-03-01) Scuarcialupi, Maria Enedina Aquino; Berton, Danilo Cortozi; Cordoni, Priscila Kessar; Squassoni, Selma Denis; Fiss, Elie; Neder, Jose Alberto [UNIFESP]; Fac Ciencias Med Paraiba; Univ Fed Rio Grande do Sul; Fac Med ABC; Queens Univ; Kingston Gen Hosp; Universidade Federal de São Paulo (UNIFESP)Objective: To investigate the modulatory effects that dynamic hyperinflation (UFO, defined as a reduction in inspiratory capacity (lC), has on exercise tolerance after bronchodilator in patients with COPD. Methods: An experimental, randomized study involving 30 COPD patients without severe hypoxemia. At baseline, the patients underwent clinical assessment, spirometry, and incremental cardiopulmonary exercise testing (CPET). On two subsequent visits, the patients were randomized to receive a combination of inhaled fenoterol/ipratropium or placebo. All patients then underwent spirometiy and submaximal CPET at constant speed up to the limit of tolerance (Tlim). The patients who showed Delta lC(peak-rest) < 0 were considered to present with DH (DH+). Results: In this sample, 21 patients (70%) had DH. The DH+ patients had higher airflow obstruction and lower Tlim than did the patients without Did (DH-). Despite equivalent improvement in FEV1 after bronchodilator, the DH- group showed higher Delta lC(bronchodilator-placebo) at rest in relation to the DH+ group (p < 0.05). However, this was not found in relation to Delta lC at peak exercise between DH+ and DH- groups (0.19 +/- 0.17 L vs. 0.17 +/- 0.15 L, p > 0.05). in addition, both groups showed similar improvements in Tlim after bronchodilator (median [interquartile range]: 22% [3-60% vs. 10% [3-53%]; p > 0.05). Conclusions: Improvement in TLim was associated with an increase in lC at rest after bronchodilator in HD- patients with COPD. However, even without that improvement, COPD patients can present with greater exercise tolerance after bronchodilator provided that they develop DH during exercise.
- ItemAcesso aberto (Open Access)Capacidade cardiorrespiratória de crianças e adolescentes com doença falciforme submetidas a teste de esforço submáximo(Universidade Federal de São Paulo (UNIFESP), 2017-03-27) Cobra, Carolina Lemos Nogueira [UNIFESP]; Braga, Josefina Aparecida Pellegrini [UNIFESP]; Johnston, Cintia; Wandalsen, Gustavo Falbo [UNIFESP]; http://lattes.cnpq.br/3003850834415505; http://lattes.cnpq.br/4807350957191775; http://lattes.cnpq.br/7645872510889651; http://lattes.cnpq.br/6774558143894982; Universidade Federal de São Paulo (UNIFESP)Objective: To evaluate the cardiorespiratory capacity of children and adolescentes with sickle cell disease submitted to a submaximal physical effort test. Methods: A unicentric, transversal and analytic study comparing 88 children and adolescentes with sickle cell disease (SCD group) with 49 healthy children and adolescentes (control group - CG), aged (patients and controls) from 6 to 18 years. Both groups were submitted to the following evaluations: cardiorespiratory capacity by the submaximal physical effort test Six-Minute Step Test - TD6', evaluated before, during (3 and 6 minutes) and after (10 minutes); heart rate (HR) and transcutaneous pulse oximetry oxygen saturation (SpO2). After the test the number of steps taken was evaluated, and the degree of fatigue and dyspnea, graduated by the scale of dyspnea and effort of Borg. Pulmonary function was evaluated before and after bronchodilator inhalation, by Spirometry. Statistical analysis: the groups were paired by age, sex, weight, height and BMI. Parametric and non-parametric methods were used depending the variables studied. Tests were considered significant when p<0.05. Results: There was no significant statistical difference in the demographic characteristics between the SCD group and the CG group. Mean age and BMI per group (SCD vs CG) 10.6 vs 9.8 years (p= 0.117) and 17.7 vs 18.8 kg/m² (p= 0,101). Comparing the spirometry parameters of SCD vs GC groups, it was observed the following diagnoses - Normal: 47 (66.2%) vs 37 (90.2%); Obstructive response to BD: 7 (9.9%) vs 2 (4.9%); Obstructive without BD response: 12 (16.9%) vs 0 (0%); Restrictive: 5 (7%) vs 2 (4.9%) p=0.003. In TD6 it was observed a significant statistical difference between SCD and CG groups regarding HR, SpO2. The number of steps taken by SCD group 126 (72-206) was lower than CG group 145 (89-289) (p <0.001). Conclusions: In this study, children and adolescents with SCD presented a cardiorespiratory response to submaximal exercise below that predicted in comparison to healthy children and adolescents with the same age and weightstature characteristics. The pulmonary function of the SCD group was predominantly obstructive pulmonary alteration not responsive to bronchodilator inhalation.
- ItemAcesso aberto (Open Access)Capacidade física e reprodutibilidade do teste de caminhada de seis minutos em crianças e adolescentes após o transplante hepático(Universidade Federal de São Paulo (UNIFESP), 2011-05-25) Silva, Rosangela Maria da [UNIFESP]; Carvalho, Werther Brunow de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introdução: O transplante hepático pediátrico é um dos mais bem sucedidos transplantes de órgãos sólidos. Independente do tipo de transplante de órgãos, a fase pós-operatória representa um período de importante redução na capacidade de exercício do receptor. Unnitban et al., 2006, reportaram baixo nível de condicionamento cardiopulmonar, em crianças após o transplante hepático, quando comparadas a crianças saudáveis. O teste de esforço cardiopulmonar é o padrão-ouro para avaliação do condicionamento cardiopulmonar. No entanto, não é um procedimento disponível para avaliação diária, sobretudo na população pediátrica, pois requer equipamentos e habilidade técnica específica. Em contraste, o teste da caminhada de seis minutos (TC6’) é um teste prático, seguro, barato, de fácil execução, que reflete melhor as atividades de vida diária. Objetivo: Avaliar a reprodutibilidade e a capacidade física do TC6’, em crianças e adolescentes após o transplante hepático, comparando-as com valores de referência obtidos em crianças brasileiras saudáveis e, secundariamente, analisar a relação entre a distância caminhada em seis minutos (DC6’) com variáveis antropométricas e clínicas. Método: Estudo transversal prospectivo, realizado de Janeiro de 2009 a Dezembro de 2010. Amostra de conveniência de 23 crianças e adolescentes no pós- transplante hepático, entre seis a dezessete anos de idade, ambos os sexos, acompanhadas no ambulatório de transplante hepático, da Universidade Federal de São Paulo, UNIFESP/EPM, São Paulo (Brasil). Medidas antropométricas e de função pulmonar foram obtidas utilizando protocolos padrão. O TC6’ foi conduzido, de acordo com os critérios da ATS 2002, em um corredor de 20 metros. Dois testes foram realizados em intervalos de trinta minutos. Os critérios de interrupção ocorreram na presença de sintomas clínicos. As variáveis fisiológicas foram mensuradas no repouso e ao final do teste. A reprodutibilidade do TC6’ foi avaliada em todas as crianças do estudo. A relação entre a distância caminhada e o trabalho (produto da distância caminhada pelo peso corpóreo) foi avaliada com medidas antropométricas, clínicas e de função pulmonar.Resultados: 23 participantes (56,5%) foram do sexo feminino e média de idade (148,87 ± 34,58 meses). A reprodutibilidade do TC6’ (ICC= 0,63) foi boa na população do estudo. Comparada aos valores de referência de Aquino et al., 2010, a média da distância caminhada das crianças e adolescentes no póstransplante foi significantemente reduzida (p<0,001). A DC6’ apresentou moderada correlação com o volume corrente (r=0,5, p<0,015). O trabalho da distância caminhada mostrou significante correlação com a idade (r=0,6 p<0,004), peso (r=0,9 p<0,001), altura (r=0,8 p<0,001), IMC (r=0,6 p<0,002), CVF (r=0,7 p<0,001), pico de fluxo (r=0,6 p<0,002) e VM (r=0,4 p<0,038). Na análise de regressão múltipla as variáveis idade, CVF e VM influenciaram em 78,6% a variância do trabalho da distância caminhada (ω). Conclusão: O TC6’ é reprodutível em crianças e adolescentes após o transplante hepático. Estes pacientes apresentaram menor capacidade física, comparativamente aos valores de referência de crianças saudáveis. O trabalho da distância caminhada (ω) parece ser um parâmetro adicional na determinação da capacidade física destes pacientes, comparado à distância caminhada isoladamente.
- ItemSomente MetadadadosDynamic hyperinflation during treadmill exercise testing in patients with moderate to severe COPD(Soc Brasileira Pneumologia Tisiologia, 2012-01-01) Cordoni, Priscila Kessar; Berton, Danilo Cortozi; Squassoni, Selma Denis; Scuarcialupi, Maria Enedina Aquino; Neder, Jose Alberto [UNIFESP]; Fiss, Elie; Universidade Federal do ABC (UFABC); Federacao Estabelecimentos Ensino Super Novo Hamb; Fac Med & Ciencias Med Paraiba; Universidade Federal de São Paulo (UNIFESP)Objective: To characterize the presence, extent, and patterns of dynamic hyperinflation (DH) during treadmill exercise testing in patients with moderate to severe COPD. Methods: This was a cross-sectional study involving 30 non-hypoxemic patients (FEV1 = 43 +/- 14% of predicted) who were submitted to a cardiopulmonary exercise test on a treadmill at a constant speed (70-80% of maximum speed) to the tolerance limit (Tlim). Serial inspiratory capacity (1C) maneuvers were used in order to assess DH. Results: Of the 30 patients studied, 19 (63.3%) presented with OH (DH+ group), having greater pulmonary function impairment at rest than did those without UN (OH group). None of the variables studied correlated with exercise tolerance in the DH- group, whereas Tlim, 1C, and perception of dyspnea during exercise did so correlate in the DH+ group (p < 0.05). In the DH+ group, 7 and 12 patients, respectively, presented with a progressive and a stable pattern of DH (Delta 1C(Tlim,2min)= -0.28 +/- 0.11 L vs. 0.04 +/- 0.10 L; p <0.01). Patients with a progressive pattern of DH presented with higher perception of dyspnea/Tlim rate and lower exercise tolerance than did those with a stable pattern (354 +/- 118 s and 465 +/- 178 s, respectively; p < 0.05). Conclusions: The presence of DH is not a universal phenomenon during walking in COPD patients, even in those with moderate to severe airflow limitation. In the patients who presented DH, a progressive pattern of DH had a greater impact on exercise tolerance than did a stable pattern of DH.
- ItemAcesso aberto (Open Access)Dynamics of chest wall volume regulation during constant work rate exercise in patients with chronic obstructive pulmonary disease(Associação Brasileira de Divulgação Científica, 2012-12-01) Takara, Luciana Shimizu [UNIFESP]; Cunha, Thulio Marquez [UNIFESP]; Barbosa, Priscila Boaventura [UNIFESP]; Rodrigues, Miguel Koite [UNIFESP]; Oliveira, Mayron Faria [UNIFESP]; Nery, Luiz Eduardo [UNIFESP]; Neder, Jose Alberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Queen’s University Department of Medicine Division of Respiratory and Critical Care MedicineThis study evaluated the dynamic behavior of total and compartmental chest wall volumes [(V CW) = rib cage (V RC) + abdomen (V AB)] as measured breath-by-breath by optoelectronic plethysmography during constant-load exercise in patients with stable chronic obstructive pulmonary disease. Thirty males (GOLD stages II-III) underwent a cardiopulmonary exercise test to the limit of tolerance (Tlim) at 75% of peak work rate on an electronically braked cycle ergometer. Exercise-induced dynamic hyperinflation was considered to be present when end-expiratory (EE) V CW increased in relation to resting values. There was a noticeable heterogeneity in the patterns of V CW regulation as EEV CW increased non-linearly in 17/30 hyperinflators and decreased in 13/30 non-hyperinflators (P < 0.05). EEV AB decreased slightly in 8 of the hyperinflators, thereby reducing and slowing the rate of increase in end-inspiratory (EI) V CW (P < 0.05). In contrast, decreases in EEV CW in the non-hyperinflators were due to the combination of stable EEV RC with marked reductions in EEV AB. These patients showed lower EIV CW and end-exercise dyspnea scores but longer Tlim than their counterparts (P < 0.05). Dyspnea increased and Tlim decreased non-linearly with a faster rate of increase in EIV CW regardless of the presence or absence of dynamic hyperinflation (P < 0.001). However, no significant between-group differences were observed in metabolic, pulmonary gas exchange and cardiovascular responses to exercise. Chest wall volumes are continuously regulated during exercise in order to postpone (or even avoid) their migration to higher operating volumes in patients with COPD, a dynamic process that is strongly dependent on the behavior of the abdominal compartment.
- ItemAcesso aberto (Open Access)Efeitos sistêmicos da hipoxemia noturna em pacientes com doença pulmonar obstrutiva crônica sem síndrome da apnéia obstrutiva do sono(Sociedade Brasileira de Pneumologia e Tisiologia, 2008-08-01) Mueller, Paulo de Tarso Guerrero; Gomes, Marcílio Delmondes; Viegas, Carlos Alberto de Assis; Neder, Jose Alberto [UNIFESP]; Universidade Federal de Mato Grosso do Sul; Clínica de Neurologia e Distúrbios do Sono; Universidade de Brasília; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To study the effects of nocturnal hypoxemia in patients with chronic obstructive pulmonary disease without obstructive sleep apnea syndrome. METHODS: We studied 21 patients-10 desaturators and 11 nondesaturators-submitted to arterial blood gas analysis, polysomnography, spirometry, cardiopulmonary exercise testing (cycle ergometer), and hand-grip dynamometry, as well as measurements of maximal inspiratory pressure, maximal expiratory pressure, and C-reactive protein (CRP) levels. Patients with arterial oxygen tension > 60 mmHg were included; those with an apnea-hypopnea index > 5 events/hour of sleep were excluded. Maximal oxygen uptake, maximal power, systolic blood pressure, diastolic blood pressure (DBP), and maximal heart rate were measured during exercise in order to detect hemodynamic alterations. Patients presenting CRP levels above 3 mg/L were considered CRP-positive. RESULTS: Minimal peripheral oxygen saturation during sleep was significantly higher among nondesaturators (p = 0.03). More desaturators presented CRP > 3 mg/L (p < 0.05). No differences were observed in terms of any variables, However, mean peripheral oxygen saturation during sleep correlated with DBP and maximal inspiratory pressure (p < 0.001 and p = 0.001, respectively). CONCLUSIONS: Although nocturnal hypoxemia does not reduce exercise capacity or hand-grip strength in patients with mild/moderate COPD, its effect on maximal exercise DBP seems to depend on the degree of hypoxemia. In addition, there is a positive relationship between maximal inspiratory pressure and mean peripheral oxygen saturation during sleep, as well as evidence of pronounced inflammatory activation in patients with nocturnal hypoxemia.
- ItemAcesso aberto (Open Access)Elaboração de equação para predição da frequência cardíaca máxima em adultos obesos durante teste de exercício cardiopulmonar em esteira(Universidade Federal de São Paulo (UNIFESP), 2018) Leiva, Thais Martins [UNIFESP]; Dourado, Victor Zuniga [UNIFESP]; Ostolin, Thatiane Lopes Valentim Di Paschoale [UNIFESP]; http://lattes.cnpq.br/4675570734968007; http://lattes.cnpq.br/1919368500743497; http://lattes.cnpq.br/0888121417241135; Universidade Federal de São Paulo (UNIFESP)Introdução: indivíduos obesos apresentam aumento do trabalho cardíaco durante o exercício devido à maior demanda metabólica e quando submetidos ao teste de exercício cardiopulmonar (TECP) tendem a atingir menor frequência cardíaca máxima (FCmax). Contudo, há poucos estudos que determinaram uma equação de predição da FCmax em adultos. Objetivo: desenvolver equações de predição da FCmax para adultos obesos brasileiros submetidos ao TECP realizado em esteira rolante e avaliar sua aplicabilidade em amostra de validação cruzada homogênea. Materiais e Métodos: Setecentos e cinquenta e cinco participantes com índice de massa corporal (IMC) ≥ 30 kg/m2 realizaram o TECP em esteira rolante. Desses, 603 preencheram os critérios de inclusão. Os participantes foram questionados sobre os fatores de risco para doenças cardiovasculares. Em seguida, foram mensurados valores antropométricos. O TECP foi realizado em esteira rolante sob protocolo rapidamente incremental do tipo “rampa”. Nele, VO2, VCO2, ventilação e FC foram monitorados. Os resultados de 80% dos 603 indivíduos randomicamente selecionados foram usados para elaborar as equações de predição da FCmax. Os demais 20% compuseram a amostra de validação cruzada, na qual se aplicaram as equações elaboradas e preexistentes. A confiabilidade das equações propostas foi investigada por meio do método gráfico de Bland and Altman. Resultados: os participantes da amostra de validação apresentaram características similares à amostra utilizada para as equações desenvolvidas. As variáveis: idade, sexo, peso, hipertensão arterial e tabagismo foram incluídas como preditores na regressão linear múltipla, explicando 48,1% da variabilidade da FCmax. Adicionalmente, desenvolvemos mais uma equação, incluindo apenas a idade. Na amostra de validação, a FCmax obtida não foi significativamente diferente da FCmax estimada [160,7 10,3 vs. 160,9 15,9 bpm (100 9%)] para a equação 1 e para a 2 [160,4 9,6 bpm (100 9%)]. A equação clássica (220 – idade) e a equação de Miller et al. superestimaram significativamente a FCmax [respectivamente, 176,5 11,2 e 179,1 5,3 bpm (91 9 e 89 8%)]. Após a análise gráfica de Bland and Altman, tanto a Equação 1, quanto a Equação 2 apresentaram concordâncias aceitáveis, em contraponto com a equação clássica e a de Miller et al. Conclusão: as equações desenvolvidas no presente estudo foram válidas e confiáveis para a predição da FCmax em adultos obesos brasileiros sem problemas de saúde relevantes, incrementando o poder interpretativo do TECP
- ItemAcesso aberto (Open Access)Equações de referência para a predição das principais relações fisiológicas submáximas em adultos submetidos ao teste de exercício cardiopulmonar incremental em esteira rolante(Universidade Federal de São Paulo, 2021-02-26) Gonze, Bárbara de Barros [UNIFESP]; Dourado, Victor Zuniga [UNIFESP]; Ostolin, Thatiane Lopes Valentim Di Paschoale [UNIFESP]; http://lattes.cnpq.br/4675570734968007; http://lattes.cnpq.br/1919368500743497; http://lattes.cnpq.br/2303420787732563INTRODUÇÃO: O Teste de Exercício Cardiopulmonar (TECP) é amplamente utilizado na prática clínica para identificar tolerância ao exercício e seus fatores limitantes. As respostas obtidas no pico do exercício são utilizadas para expressar a aptidão cardiorrespiratória deadultos. Apesar da importância dos valores de pico, a interpretação e o valor prognóstico do TECP podem ser aprimorados por meio da análise das relações submáximas de variáveis-chave, como eficiência cardiovascular (ΔFC/ΔVO2, eficiência ventilatória (∆VE/∆ VCO2), padrão ventilatório (∆VC/∆lnVE) e eficiência do consumo de oxigênio (OUES). Além da inclinação dessas relações, seus interceptos em y também foram identificados, mais recentemente, como clinicamente importantes. Embora valores de referência dessas variáveis no TECP realizado em cicloergômetro já existam, sob nosso conhecimento, tais informações não estão disponíveis em esteira rolante. OBJETIVO: Propor valores e equações de referência para a predição das principais relações fisiológicas submáximas dinâmicas em adultos submetidos ao teste de exercício cardiopulmonar incremental em esteira rolante. MÉTODOS: Submetemos 1.517 indivíduos adultos (60% mulheres) ao TECP realizado em esteira rolante, sob protocolo de rampa. Indivíduos com distúrbios cardiopulmonares ou eletrocardiográficos foram excluídos da amostra final (n=1.295). Dados demográficos, antropométricos e fatores de risco cardiovascular (RCV) foram obtidos. Elaboramos equações de regressão múltipla linear do tipo enter, para a predição das respostas fisiológicas submáximas, considerarando idade, sexo, massa corporal, estatura e inatividade física como potenciais preditores. RESULTADOS: Idade, sexo, massa corporal, estatura e inatividade física explicaram entre 2,9 e 57% da variabilidade total das variáveis estudadas. Estes preditores influenciaram 33, 47 e 57% da variabilidade do padrão respiratório, eficiência cardiovascular e OUES, respectivamente. Por outro lado, apresentaram influência limitada para eficiência ventilatória (6,4%) e para os interceptos em y. CONCLUSÃO: Eficiência cardiovascular e OUES, bem como padrão ventilatório durante o esforço, podem ser adequadamente preditos por variáveis demográficas, antropométricas e RCV.
- ItemAcesso aberto (Open Access)Equações de referência para os testes de caminhada de campo em adultos saudáveis(Sociedade Brasileira de Pneumologia e Tisiologia, 2011-10-01) Dourado, Victor Zuniga [UNIFESP]; Vidotto, Milena Carlos [UNIFESP]; Guerra, Ricardo Luís Fernandes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To develop regression equations for predicting six-minute and incremental shuttle walk distances (6MWD and ISWD, respectively), based on demographic characteristics, anthropometric variables, and grip strength. METHODS: We evaluated 6MWD and ISWD in 98 healthy adults. Height, weight, and grip strength were also assessed. Using data from 90 of the participants (40 males; 60 ± 9 years of age), we devised linear equations adjusted for age, gender, height, and weight, and we developed alternate models that included grip strength. We prospectively applied the equations in the 8 remaining participants (4 males; 59 ± 10 years), who had been randomly separated from the initial sample. RESULTS: Age, gender, height, and weight collectively explained 54.5% and 64.9% of the variance in 6MWD and ISWD, respectively, whereas age, height, weight, and grip strength collectively explained 54.4% and 69.0% of the respective variances. There was no significant difference between the measured and predicted 6MWD using equations with and without grip strength (14 ± 57 vs. 13 ± 67 m). Similar results were observed for ISWD (25 ± 104 vs. 25 ± 93 m). CONCLUSIONS: Grip strength is a determinant of ISWD and 6MWD; however, it could not improve the power of equations adjusted by demographic and anthropometric variables. The validity of our models including grip strength should be further evaluated in patients with skeletal muscle dysfunction.
- ItemAcesso aberto (Open Access)Exercise may cause myocardial ischemia at the anaerobic threshold in cardiac rehabilitation programs(Associação Brasileira de Divulgação Científica, 2009-03-01) Fuchs, Angela Rúbia Cavalcanti Neves [UNIFESP]; Meneghelo, Romeu Sergio; Stefanini, Edson [UNIFESP]; De Paola, Angelo Amato Vincenzo [UNIFESP]; Smanio, Paola Emanuela Poggio; Mastrocolla, Luiz Eduardo; Ferraz, Almir Sergio; Buglia, Susimeire; Piegas, Leopoldo Soares; Carvalho, Antonio Carlos [UNIFESP]; Instituto Dante Pazzanese de Cardiologia Serviço de Reabilitação Cardiovascular; Instituto Dante Pazzanese de Cardiologia Seção Médica de Medicina Nuclear; Instituto Dante Pazzanese de Cardiologia Departamento de Saúde; Universidade Federal de São Paulo (UNIFESP)Myocardial ischemia may occur during an exercise session in cardiac rehabilitation programs. However, it has not been established whether it is elicited when exercise prescription is based on heart rate corresponding to the anaerobic threshold as measured by cardiopulmonary exercise testing. Our objective was to determine the incidence of myocardial ischemia in cardiac rehabilitation programs according to myocardial perfusion SPECT in exercise programs based on the anaerobic threshold. Thirty-nine patients (35 men and 4 women) diagnosed with coronary artery disease by coronary angiography and stress technetium-99m-sestamibi gated SPECT associated with a baseline cardiopulmonary exercise test were assessed. Ages ranged from 45 to 75 years. A second cardiopulmonary exercise test determined training intensity at the anaerobic threshold. Repeat gated-SPECT was obtained after a third cardiopulmonary exercise test at the prescribed workload and heart rate. Myocardial perfusion images were analyzed using a score system of 6.4 at rest, 13.9 at peak stress, and 10.7 during the prescribed exercise (P < 0.05). The presence of myocardial ischemia during exercise was defined as a difference ≥2 between the summed stress score and summed rest score. Accordingly, 25 (64%) patients were classified as ischemic and 14 (36%) as nonischemic. MIBI-SPECT showed myocardial ischemia during exercise within the anaerobic threshold. The 64% prevalence of ischemia observed in the study should not be looked on as representative of the whole population of patients undergoing exercise programs. Changes in patient care and exercise programs were implemented as a result of our finding of ischemia during the prescribed exercise.
- ItemSomente MetadadadosIncremental exercise test for the evaluation of peak oxygen consumption in paralympic swimmers(Edizioni Minerva Medica, 2016) Souza, Helton de Sa [UNIFESP]; Alves, Eduardo da Silva [UNIFESP]; Ortega, Luciana; Silva, Andressa [UNIFESP]; Esteves, Andrea Maculano [UNIFESP]; Schwingel, Paulo Adriano; Vital, Roberto; Rocha, Edilson Alves da; Rodrigues, Bruno; Lira, Fabio Santos de [UNIFESP]; Tufik, Sergio [UNIFESP]; Mello, Marco Tulio de [UNIFESP]BACKGROUND: Peak oxygen consumption (VO(2)peak) is a fundamental parameter used to evaluate physical capacity. The objective of this study was to explore two types of incremental exercise tests used to determine VO(2)peak in four Paralympic swimmers: arm ergometer testing in the laboratory and testing in the swimming pool. METHODS: On two different days, the VO(2)peak values of the four athletes were measured in a swimming pool and by a cycle ergometer. The protocols identified the VO(2)peak by progressive loading until the volitional exhaustion maximum was reached. The results were analyzed using the paired Student's t-test, Cohen's d effect sizes and a linear regression. RESULTS: The results showed that the VO(2)peak values obtained using the swimming pool protocol were higher (P=0.02) than those obtained by the arm ergometer (45.8 +/- 19.2 vs. 30.4 +/- 15.5
- ItemAcesso aberto (Open Access)Influência do dreno pleural sobre a dor, capacidade vital e teste de caminhada de seis minutos em pacientes submetidos à ressecção pulmonar(Sociedade Brasileira de Pneumologia e Tisiologia, 2008-12-01) Lima, Vanessa Pereira de [UNIFESP]; Bonfim, Daniela [UNIFESP]; Risso, Thais Telles [UNIFESP]; Paisani, Denise de Moraes [UNIFESP]; Fiore Junior, Julio Flavio; Chiavegato, Luciana Dias [UNIFESP]; Faresin, Sonia Maria [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Cidade de São PauloOBJECTIVE: To evaluate the influence of pleural drainage on the distance covered on the six-minute walk test, pain intensity and vital capacity in patients submitted to pulmonary resection. METHODS: Thirteen consecutive patients from the Thoracic Surgery Infirmary of Hospital São Paulo, Brazil, submitted to closed pleural drainage (0.5-in multiperforated chest tube) in the postoperative period following pulmonary resection (lobectomy, segmentectomy and pulmonary nodule resection) were evaluated. The decision for chest tube removal followed clinical criteria defined by the surgical team, who did not participate in the study. Vital capacity, pain intensity (using a visual analog pain scale) and the distance covered on the six-minute walk test were determined 30 min prior to and 30 min after the removal of the chest tube. The statistical analysis was performed using paired t-tests, and the level of significance was set at 0.05. RESULTS: After the removal of the chest tube, the visual analog scale pain scores were significantly lower (3.46 cm vs. 1.77 cm; p = 0.001) and the distance covered on the six-minute walk test was significantly higher (374.34 m vs. 444.62 m; p = 0.03). Vital capacity prior to and after chest tube removal was not significantly affected (2.15 L and 2.25 L, respectively; p = 0.540). CONCLUSIONS: The results of the present study suggest that the presence of a chest tube is a factor significantly associated with postoperative pain and functional limitation in patients submitted to pulmonary resection.
- ItemAcesso aberto (Open Access)Instrumentos de avaliação da funcionalidade em pacientes críticos com covid-19: uma revisão de literatura(Universidade Federal de São Paulo, 2021-07-28) Gomes, Rosemeire da Silva [UNIFESP]; Volpe, Márcia Souza [UNIFESP]; http://lattes.cnpq.br/2284535375174765; http://lattes.cnpq.br/4164134731021784; Universidade Federal de São Paulo (UNIFESP)INTRODUÇÃO: Em março de 2020 a Organização Mundial da Saúde declarou pandemia do novo coronavírus, SARS-CoV-2, e a doença foi denominada de COVID-19. A maioria dos infectados desenvolve a forma leve da doença, porém cerca de 15% necessitam de hospitalização. Esses pacientes podem desenvolver insuficiência respiratória e necessitar de ventilação mecânica invasiva. O tempo de internação prolongado e a gravidade da doença podem acarretar perda da capacidade funcional. OBJETIVO: O objetivo deste estudo foi investigar, por meio de uma revisão de literatura, quais são os instrumentos utilizados para avaliar a capacidade funcional de pacientes críticos com COVI-19 durante a internação hospitalar. MÉTODOS: Foram realizadas buscas no período de fevereiro de 2020 a junho de 2021, nos idiomas inglês e português, na base de dados PubMed. Os descritores foram identificados no DeCS e Mesh. Sendo elas: COVID-19, recuperação da função, atividade de vida diária ou desempenho físico funcional, reabilitação, teste de exercício e alta hospitalar. A análise dos artigos foi realizada pela plataforma Rayyan, inicialmente com dois avaliadores de forma independente, e quando houve conflito, foi avaliado por um terceiro avaliador. RESULTADOS: Foram encontrados 29 artigos, dos quais após a leitura dos títulos e resumos, foram selecionados 15 estudos. Desse total restaram 9 artigos. A partir dessa leitura, identificamos mais 3 artigos, totalizando 12 estudos. Foram encontrados os seguintes testes: teste de caminhada de 6 minutos (TC6min), teste de caminhada de 2 minutos (TC2min), short physical performance battery (SPPB) e o medical research council (MRC), força de preensão palmar. CONCLUSÃO: Os instrumentos de avaliação da capacidade funcional mais comuns foram o MRC e o SPPB em ambiente hospitalar e o TC6min após a alta.
- ItemAcesso aberto (Open Access)No limiar anaeróbico ventilatório exercício pode causar isquemia miocárdica em programa de reabilitação cardiovascular(Universidade Federal de São Paulo (UNIFESP), 2009-01-28) Fuchs, Angela Rúbia Cavalcanti Neves [UNIFESP]; Carvalho, Antonio Carlos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background: Myocardial ischemia may occur during an exercise session in cardiac rehabilitation programs. However, it has not been established whether it is elicited when exercise prescription is based on heart rate corresponding to the anaerobic threshold as measured by cardiopulmonary exercise testing. Objectives: To assess the incidence of myocardial ischemia in cardiac rehabilitation programs according to myocardial perfusion SPECT in exercise programs based on the anaerobic threshold. Methods: Thirty-nine patients (35 men and 4 women) diagnosed with coronary artery disease by coronary angiography and stress technetium-99msestamibi gated SPECT associated with a baseline cardiopulmonary exercise test were assessed. Ages ranged from 45 to 75 years. A second cardiopulmonary exercise testing determined training intensity at the anaerobic threshold. Repeat gated-SPECT was obtained after a third cardiopulmonary exercise testing at the prescribed workload and heart rate. Results: Myocardial perfusion images, analyzed using a score system: 6.4 at rest, 13.9 at peak stress, and 10.7 during the prescribed exercise (p<0.05). The presence of myocardial ischemia during exercise was defined as a difference ³ 2 between the summed stress score and summed rest score. Accordingly, 25 (64%) patients were classified as ischemic and 14 (36%) as nonischemic. Conclusion: MIBI-SPECT has shown myocardial ischemia during exercise within the anaerobic threshold. The 64% prevalence of ischemia observed in the study should not be looked on as representative of the whole population of patients undergoing exercise program. The changes in patient care and exercise program were implemented as a result of our findings (ischemia during the prescribed exercise).
- ItemAcesso aberto (Open Access)Translation and cross-cultural adaptation of the Duke activity status index to Brazilian Portuguese(Pontifícia Universidade Católica do Paraná, 2013-09-01) Neves, Laura Maria Tomazi; Alberto, Klohn Neto [UNIFESP]; Arenas, Fernanda Pasquale [UNIFESP]; Luis Vicente Franco De, Oliveira; Arena, Ross; Cipriano Junior, Gerson [UNIFESP]; Brasília University; Universidade Federal de São Paulo (UNIFESP); Nove de Julho University; University of Illinois Chicago College of Applied Health Sciences University of Illinois Chicago; Brasília University Physical Therapy CourseINTRODUCTION: The limited number of valid and reliable questionnaires for the evaluation of exercise tolerance has stimulated the development of simple international assessment tools for this purpose, one of the most widely used of which is the Duke Activity Status Index (DASI). However, this index has not yet been translated and adapted to the Portuguese language. OBJECTIVE: To develop a Brazilian version of the DASI and cross-culturally adapt it for the evaluation of cardiorespiratory fitness among patients with cardiovascular disease in Brazil. MATERIALS AND METHODS: The translation process involved four stages: initial translation, back-translation, multidisciplinary committee review and pre-test with 16 subjects (8 cardiac patients and 8 healthy individuals). Patients were screened from outpatient Cardiac Surgery, São Paulo Hospital. The Mann-Whitney and chi-square tests were employed to determine differences between controls and individuals with heart disease. RESULTS: The sample was characterized by individuals aged ≥ 50 years who were mainly from the southeastern region of Brazil (62.5%) and were non-smokers (56.2%). Less than half of the cohort was considered physically active (43.75%). The level of non-understanding was less than 10% of the sample. Doubts were prevalent among individuals with heart disease (75%) regarding the level of fatigue caused when performing a task. CONCLUSION: The present findings demonstrate that the DASI was successfully translated and adapted to Brazilian Portuguese.
- ItemAcesso aberto (Open Access)Valores de referência para o teste de caminhada com carga progressiva em indivíduos saudáveis: da distância percorrida às respostas fisiológicas(Sociedade Brasileira de Pneumologia e Tisiologia, 2013-04-01) Dourado, Victor Zuniga [UNIFESP]; Guerra, Ricardo Luís Fernandes [UNIFESP]; Tanni, Suzana Erico; Antunes, Letícia Cláudia De Oliveira; Godoy, Irma; Universidade Federal de São Paulo (UNIFESP); Universidade Estadual Paulista (UNESP); Faculdade Marechal RondonOBJECTIVE: To determine reference values for incremental shuttle walk distance (ISWD) and peak physiological responses during the incremental shuttle walk test (ISWT), as well as to develop a series of predictive equations for those variables in healthy adults. METHODS: We evaluated 103 healthy participants > 40 years of age (54 women and 49 men). We fitted each participant with a gas analysis system for use during the ISWT. Oxygen consumption (VO2), carbon dioxide production, minute ventilation, heart rate (HR), ISWD, and maximal walking velocity (MWV) were obtained as primary outcomes. We also assessed hand grip strength (HGS) and lean body mass (LBM). RESULTS: The regression analysis models, including physiological variables, ISWD, and MWV (adjusted for age, body mass, height, and sex), produced R² values ranging from 0.40 to 0.65 (for HR and peak VO2, respectively). Using the models including LBM or HGS, we obtained no significant increase in the R² values for predicting peak VO2, although the use of those models did result in slight increases in the R² values for ISWD and MWV (of 8% and 12%, respectively). The variables ISWD, MWV, and ISWD × body mass, respectively, explained 76.7%, 73.3%, and 81.2% of peak VO2 variability. CONCLUSIONS: Our results provide reference values for ISWD and physiological responses to the ISWT, which can be properly estimated by determining simple demographic and anthropometric characteristics in healthy adults > 40 years of age. The ISWT could be used in assessing physical fitness in the general adult population and in designing individualized walking programs.