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Araújo CO, Araújo Alves CC, Santos FRA, Cahalin LP, Cipriano GFB, Cipriano G. Inspiratory Muscle Training in Phase 1 and 2 Postoperative Cardiac Rehabilitation Following Coronary Artery Bypass Graft Surgery: Systematic Review with Meta-Analysis. Phys Ther 2024:pzae061. [PMID: 38624192 DOI: 10.1093/ptj/pzae061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 04/03/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVE This study aimed to determine the effects of inspiratory muscle training (IMT) on exercise capacity, respiratory muscle strength, length of hospital stay (LOS), and quality of life (QOL) following coronary artery bypass graft surgery. METHODS The search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Cochrane Handbook and included the databases MEDLINE, EMBASE, CINAHL, Scopus, and CENTRAL. The review included randomized controlled trials utilizing IMT during phase 1 or 2 postoperative cardiac rehabilitation (PoCR) versus alternative treatment (active or passive control) in patients following coronary artery bypass graft surgery. RESULTS Fifteen studies were included (11 phase 1 studies, 4 phase 2 studies) with no reported adverse events. In phase 1 PoCR, IMT reduced the LOS (-1.02 days; 95% CI = -2.00 to -0.03) and increased exercise capacity (6-minute walk distance [6MWD]).(+75.46 m; 95% CI = 52.34 to 98.57), and maximal inspiratory pressure (MIP) (10.46 cm H2O; 95% CI = 2.83 to 18.10), but had no effect on maximal expiratory pressure. In phase 2 PoCR, IMT increased 6MWD (45.84 m; 95% CI = 10.89 to 80.80), MIP (-23.19 cm H2O; 95% CI = -31.31 to -15), maximal expiratory pressure (20.18 cm H2O; 95% CI = 9.60 to 30.76), and QOL (-11.17; 95% CI = -17.98 to -4.36), with no effect on peak oxygen uptake. There was a high risk of bias for MIP (75% of the phase 1 studies) and 6MWT (1 of 4 phase 2 studies). The quality of the evidence ranged from very low to moderate. CONCLUSIONS IMT significantly improves exercise capacity, respiratory muscle strength, LOS, and QOL in phase 1 and 2 PoCR. IMPACT IMT may benefit patients during phase 1 and 2 of PoCR, considering the safety, low cost, and potential benefits.
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Affiliation(s)
| | | | - Francisco R A Santos
- Science and Technology in Health Program, University of Brasília, Brasília, Brazil
| | - Lawrence P Cahalin
- Graduate Program in Human Movement and Rehabilitation of Unievangélica, University of Goias, Anápolis, Brazil
| | - Graziella França Bernardelli Cipriano
- Science and Technology in Health Program, University of Brasília, Brasília, Brazil
- Science of Rehabilitation Program, University of Brasília, Brasília, Brazil
| | - Gerson Cipriano
- Science and Technology in Health Program, University of Brasília, Brasília, Brazil
- Science of Rehabilitation Program, University of Brasília, Brasília, Brazil
- Department of Physical Therapy. Leonard M. Miller School of Medicine. University of Miami, Miami, FL, USA
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Genovese C, Rizzo CE, La Spina I, Tripodi P, Biondo AC, Lo Prete V, Genovese MPA, Balsamo DG, Cipriano G, Genovese G, Nicita A, La Spada G, La Fauci V, Squeri R. A Southern addiction evaluation project: investigating the impact of addiction through a survey HBSC based. Clin Ter 2024; 175:144-152. [PMID: 38571473 DOI: 10.7417/ct.2024.5047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
Background Adolescence is a critical phase of development characterized by numerous physical, psychological and social changes. During this stage, individuals may engage in experimentation and risky behavior, leading to increased vulnerability to addiction. This article aims to present the results of a survey based on the HBSC (Health Behavior in School-aged Children) surveillance model in a province of Southern Italy for primary and secondary school students. Methods We conducted a prospective study from March 2020 to April 2023 through the administration of a questionnaire to students of the healthcare faculties of the University of Messina and primary and secondary school students, composed of 19 items and based on HBSC surveillance. Results We collected a total of 664 questionnaires. We found that smoking habits increase with age: approximately 31% of secondary school students declare they are real smokers compared to 40% of HCP students. At least once, in the three study groups, students experienced alcohol consumption at different rates, with younger students having a greater propensity to drink than older students. Fortunately, in our sample, no middle school students had tried cannabis. At the same time there is a surprising decrease in gambling in all categories compared to national data. Conclusions The presence of addictive behaviors in our sample was found to be widespread despite being in line with the national trend. Furthermore, we have observed a reduction in recent years which needs to be investigated to assess the reasons. Primary prevention is probably the main weapon in the hands of politicians and must be applied early in school and community settings to reduce prevalence.
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Affiliation(s)
- C Genovese
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - C E Rizzo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - I La Spina
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - P Tripodi
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - A C Biondo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - V Lo Prete
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - M P A Genovese
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - D G Balsamo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - G Cipriano
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - G Genovese
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - A Nicita
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - G La Spada
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - V La Fauci
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - R Squeri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
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D'Ávila LBO, Milani M, Le Bihan DCS, de Lima ACGB, Milani JGPO, Cipriano GFB, da Silva VZM, Cipriano G. Longitudinal strain and myocardial work in symptomatic patients having recovered from COVID-19 and possible associations with the severity of the disease. Int J Cardiovasc Imaging 2024:10.1007/s10554-023-03042-2. [PMID: 38277026 DOI: 10.1007/s10554-023-03042-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/24/2023] [Indexed: 01/27/2024]
Abstract
COVID-19 may have residual consequences in multiple organs, including the cardiovascular system. The purpose of the present investigation is to quantify myocardial function in symptomatic individuals with long COVID and investigate the association between illness severity and myocardial function. A retrospective cross-sectional study was conducted in which symptomatic individuals with previous COVID-19 underwent echocardiographic analysis of left ventricle global longitudinal strain (LVGLS) and myocardial work (MW). Individuals also performed cardiopulmonary testing (CPX) to assess peak oxygen uptake (VO2peak). Differences between illness severity subgroups were analyzed by the Mann-Whitney test. Correlations were calculated using the Spearman correlation test. Multilinear regressions were performed to evaluate the influences of COVID-19 severity, body mass index, age, and sex on MW. Fifty-six individuals were included (critical subgroup: 17; moderate/severe subgroup: 39), 59% females; median age: 56 years (IQR: 43-63). CPX revealed a substantial reduction in VO2peak (median of 53% of predicted values). LVGLS were not statistically different between subgroups. Global wasted work (GWW) was higher in the critical subgroup [146 (104-212) versus 121 (74-163) mmHg%, p = 0.01], and global work efficiency (GWE) was lower in this subgroup [93 (91-95) versus 94 (93-96), p = 0.03]. Illness severity was the only independent predictor of GWW and GWE (GWW: r2 = 0.167; p = 0.009; GWE: r2 = 0.172; p = 0.005) in multilinear regressions. In our study with long COVID-19 individuals, despite having a similar LVGLS, patients had subclinical LV dysfunction, demonstrated only by an increase in GWW and a decrease in GWE.
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Affiliation(s)
- Luciana Bartolomei Orru D'Ávila
- Health Sciences and Technologies Graduate Program, University of Brasilia (UnB), Brasilia, DF, Brazil.
- Medcor, CLSW 105 Bloco A salas 37 a 39 Sudoeste, Brasilia, DF, CEP: 70670431, Brazil.
| | - Mauricio Milani
- Health Sciences and Technologies Graduate Program, University of Brasilia (UnB), Brasilia, DF, Brazil
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Rehabilitation Sciences Program, University of Brasilia (UnB), Brasilia, DF, Brazil
| | - David C S Le Bihan
- University of São Paulo | USP Heart Institute São Paulo (InCor), São Paulo, SP, Brazil
| | | | - Juliana Goulart Prata Oliveira Milani
- Health Sciences and Technologies Graduate Program, University of Brasilia (UnB), Brasilia, DF, Brazil
- REVAL/BIOMED, Hasselt University, Hasselt, Belgium
| | - Graziella França Bernardelli Cipriano
- Health Sciences and Technologies Graduate Program, University of Brasilia (UnB), Brasilia, DF, Brazil
- Rehabilitation Sciences Program, University of Brasilia (UnB), Brasilia, DF, Brazil
| | | | - Gerson Cipriano
- Health Sciences and Technologies Graduate Program, University of Brasilia (UnB), Brasilia, DF, Brazil
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Frazão M, Cipriano G, Silva PE. Does inflammation and altered metabolism impede efficacy of functional electrical stimulation in critically ill patients? Unleashing the potential of individualized functional electrical stimulation-cycling in critical illness. Crit Care 2024; 28:8. [PMID: 38167053 PMCID: PMC10759332 DOI: 10.1186/s13054-023-04788-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024] Open
Affiliation(s)
- Murillo Frazão
- Lauro Wanderley University Hospital, Avenida Ruy Carneiro, 412, Miramar, João Pessoa, PB, 58302-100, Brazil.
- Health Sciences and Technologies Graduate Program, University of Brasilia (UnB), Brasilia, DF, Brazil.
| | - Gerson Cipriano
- Health Sciences and Technologies Graduate Program, University of Brasilia (UnB), Brasilia, DF, Brazil
- Graduate Program in Human Movement, Rehabilitation of Evangelical University of Goias, Anapolis, Brazil
| | - Paulo Eugênio Silva
- University of São Paulo Medical School, São Paulo, SP, Brazil
- Hospital de Base Do Distrito Federal-IGESDF, Brasília, DF, Brazil
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dos Santos DS, Queiroz CO, Dias CMCC, Cipriano G, Borges QO, Ritt LEF. Prediction of Peak Oxygen Consumption in Patients with Heart Disease Based on Performance on the Timed Up and Go Test. Arq Bras Cardiol 2023; 120:e20230338. [PMID: 38126569 PMCID: PMC10789370 DOI: 10.36660/abc.20230338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/14/2023] [Accepted: 10/04/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Central Illustration : Prediction of Peak Oxygen Consumption in Patients with Heart Disease Based on Performance on the Timed Up and Go Test CPET: cardiopulmonary exercise test; TUG: timed up and go test; VO2peak: peak oxygen consumption. BACKGROUND The use of the timed up and go (TUG) test to assess cardiorespiratory fitness in patients with heart disease has not been well defined in the literature. OBJECTIVES Test the association between TUG and peak oxygen consumption (VO2peak), construct an equation based on TUG to predict VO2peak, and determine a cutoff point to estimate VO2peak ≥ 20 mL/kg/min. METHODS This cross-sectional study included 201 patients with coronary artery disease or heart failure, between 36 and 92 years of age, who underwent TUG and cardiopulmonary exercise test. Correlation, ROC curve, multiple linear regression, and Bland-Altman analyses were performed. The significance level was set at p < 0.05. RESULTS The mean age of the total sample was 67 ± 13 years, and 70% of participants were male. The mean VO2peak was 17 ± 6 mL/kg/min, and the mean TUG time was 7 ± 2.5 seconds. The correlation between VO2peak and TUG was r = -0.54 (p < 0.001), and R2 was 0.30. The following equation was developed based on TUG: V O 2 peak = 33.553 + ( - 0.149 × age ) + ( - 0.738 × TUG ) + ( - 2.870 × sex ) ; a value of 0 was assigned to the male sex and 1 to the female sex (adjusted R: 0.41; adjusted R2: 0.40). The VO2peak estimated by the equation was 18.81 ± 3.2 mL/kg/min, and the VO2peak determined by cardiopulmonary exercise test was 18.18 ± 5.9 mL/kg/min (p > 0.05). The best cutoff point in the TUG for VO2peak ≥ 20 mL/kg/min was ≤ 5.47 seconds (area under the curve: 0.80; 95% confidence interval: 0.74 to 0.86). CONCLUSIONS TUG and VO2peak showed a significant association. A prediction equation for VO2peak was developed and validated internally with good performance. The cutoff point in the TUG to predict VO2peak ≥ 20 mL/kg/min was ≤ 5.47 seconds.
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Affiliation(s)
- Danilo Silva dos Santos
- Escola Bahiana de Medicina e Saúde PúblicaUnidade Acadêmica BrotasSalvadorBABrasilEscola Bahiana de Medicina e Saúde Pública – Unidade Acadêmica Brotas, Salvador, BA – Brasil
| | - Ciro Oliveira Queiroz
- Universidade Estadual do Sudoeste da BahiaJequieBrasilUniversidade Estadual do Sudoeste da Bahia – Campus de Jequie, Jequie – Brasil
| | - Cristiane Maria Carvalho Costa Dias
- Escola Bahiana de Medicina e Saúde PúblicaUnidade Acadêmica BrotasSalvadorBABrasilEscola Bahiana de Medicina e Saúde Pública – Unidade Acadêmica Brotas, Salvador, BA – Brasil
| | - Gerson Cipriano
- Universidade de BrasíliaBrasíliaDFBrasilUniversidade de Brasília, Brasília, DF – Brasil
| | - Queila Oliveira Borges
- Hospital Cardio PulmonarCentro de Estudos ClínicosSalvadorBABrasilHospital Cardio Pulmonar – Centro de Estudos Clínicos, Salvador, BA – Brasil
| | - Luiz Eduardo Fonteles Ritt
- Escola Bahiana de Medicina e Saúde PúblicaUnidade Acadêmica BrotasSalvadorBABrasilEscola Bahiana de Medicina e Saúde Pública – Unidade Acadêmica Brotas, Salvador, BA – Brasil
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Vieira L, Silva PE, de Melo PF, Maldaner V, Durigan JQ, Marqueti RDC, Nobrega O, Mathur S, Burtin C, Barin F, Machado-Silva W, Ramalho S, Chiappa GR, Gomes NO, Carvalho CRF, Cipriano GFB, Cipriano G. Early Neuromuscular Electrical Stimulation Preserves Muscle Size and Quality and Maintains Systemic Levels of Signaling Mediators of Muscle Growth and Inflammation in Patients with Traumatic Brain Injury: A Randomized Clinical Trial. Crit Care Res Pract 2023; 2023:9335379. [PMID: 37547450 PMCID: PMC10397495 DOI: 10.1155/2023/9335379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/15/2022] [Accepted: 06/26/2023] [Indexed: 08/08/2023] Open
Abstract
Objective To investigate the effects of an early neuromuscular electrical stimulation (NMES) protocol on muscle quality and size as well as signaling mediators of muscle growth and systemic inflammation in patients with traumatic brain injury (TBI). Design Two-arm, single-blinded, parallel-group, randomized, controlled trial with a blinded assessment. Setting. Trauma intensive care unit at a university hospital. Participants. Forty consecutive patients on mechanical ventilation (MV) secondary to TBI were prospectively recruited within the first 24 hours following admission. Interventions. The intervention group (NMES; n = 20) received a daily session of NMES on the rectus femoris muscle for five consecutive days (55 min/each session). The control group (n = 20) received usual care. Main Outcome Measures. Muscle echogenicity and thickness were evaluated by ultrasonography. A daily blood sample was collected to assess circulating levels of insulin-like growth factor I (IGF-I), inflammatory cytokines, and matrix metalloproteinases (MMP). Results Both groups were similar at baseline. A smaller change in muscle echogenicity and thickness (difference between Day 1 and Day 7) was found in the control group compared to the NMES group (29.9 ± 2.1 vs. 3.0 ± 1.2, p < 0.001; -0.79 ± 0.12 vs. -0.01 ± 0.06, p < 0.001, respectively). Circulating levels of IGF-I, pro-inflammatory cytokines (IFN-y), and MMP were similar between groups. Conclusion An early NMES protocol can preserve muscle size and quality and maintain systemic levels of signaling mediators of muscle growth and inflammation in patients with TBI. This trial is registered with https://www.ensaiosclinicos.gov.br under number RBR-2db.
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Affiliation(s)
- Luciana Vieira
- University of Brasilia, Faculty of Ceilãndia, Sciences and Technologies in Health Program (PPGCTS), Brasília, DF, Brazil
- Physical Therapy Division, Hospital de Base do Distrito Federal, Brasília, DF, Brazil
| | - Paulo Eugênio Silva
- University of Brasilia, Faculty of Ceilãndia, Sciences and Technologies in Health Program (PPGCTS), Brasília, DF, Brazil
- Physical Therapy Division, Hospital de Base do Distrito Federal, Brasília, DF, Brazil
| | - Priscilla Flavia de Melo
- University of Brasilia, Faculty of Ceilãndia, Sciences and Technologies in Health Program (PPGCTS), Brasília, DF, Brazil
- Physical Therapy Division, Hospital de Base do Distrito Federal, Brasília, DF, Brazil
| | - Vinicius Maldaner
- University of Brasilia, Faculty of Ceilãndia, Sciences and Technologies in Health Program (PPGCTS), Brasília, DF, Brazil
- Human Movement and Rehabilitation Program, UniEVANGÉLICA, Anápolis, GO, Brazil
| | - Joao Q. Durigan
- University of Brasilia, Faculty of Ceilãndia, Sciences and Technologies in Health Program (PPGCTS), Brasília, DF, Brazil
- University of Brasilia, Faculty of Ceilãndia, Rehabilitation Sciences Program (PPGCR), Brasília, DF, Brazil
| | - Rita de Cassia Marqueti
- University of Brasilia, Faculty of Ceilãndia, Sciences and Technologies in Health Program (PPGCTS), Brasília, DF, Brazil
- University of Brasilia, Faculty of Ceilãndia, Rehabilitation Sciences Program (PPGCR), Brasília, DF, Brazil
| | - Otavio Nobrega
- University of Brasilia, Faculty of Ceilãndia, Sciences and Technologies in Health Program (PPGCTS), Brasília, DF, Brazil
- Medical Sciences Graduate Program (PPGCM), University of Brasilia (UnB), Brasília, DF, Brazil
| | - Sunita Mathur
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Chris Burtin
- Rehabilitation Research Centre, Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Fabrício Barin
- University of Brasilia, Faculty of Ceilãndia, Sciences and Technologies in Health Program (PPGCTS), Brasília, DF, Brazil
| | - Wilcelly Machado-Silva
- University of Brasilia, Faculty of Ceilãndia, Sciences and Technologies in Health Program (PPGCTS), Brasília, DF, Brazil
| | - Sergio Ramalho
- University of Brasilia, Faculty of Ceilãndia, Sciences and Technologies in Health Program (PPGCTS), Brasília, DF, Brazil
| | - Gaspar R. Chiappa
- Human Movement and Rehabilitation Program, UniEVANGÉLICA, Anápolis, GO, Brazil
| | | | | | - Graziella F. B. Cipriano
- University of Brasilia, Faculty of Ceilãndia, Sciences and Technologies in Health Program (PPGCTS), Brasília, DF, Brazil
- University of Brasilia, Faculty of Ceilãndia, Rehabilitation Sciences Program (PPGCR), Brasília, DF, Brazil
| | - Gerson Cipriano
- University of Brasilia, Faculty of Ceilãndia, Sciences and Technologies in Health Program (PPGCTS), Brasília, DF, Brazil
- Human Movement and Rehabilitation Program, UniEVANGÉLICA, Anápolis, GO, Brazil
- University of Brasilia, Faculty of Ceilãndia, Rehabilitation Sciences Program (PPGCR), Brasília, DF, Brazil
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de Araújo Morais L, Cipriano G, Martins WR, Chiappa GR, Formiga MF, Cipriano GFB. Inspiratory muscle training on quality of life in individuals with spinal cord injury: A systematic review and meta-analysis. Spinal Cord 2023; 61:359-367. [PMID: 37393409 DOI: 10.1038/s41393-023-00906-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/03/2023]
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVES The objective was to summarize the effectiveness of Inspiratory Muscle Training (IMT) on the quality of life in individuals with Spinal Cord Injury (SCI). METHODS An online systematic literature search was conducted in the following databases: PubMed/MEDLINE, PubMed CENTRAL, EMBASE, ISI Web of Science, SciELO, CINAHL/SPORTDiscus, and PsycINFO. Randomized and non-randomized clinical studies investigating the effectiveness of IMT in quality of life were included in the present study. The results used the mean difference and 95% confidence interval for maximal inspiratory pressure (MIP), forced expiratory volume in 1 s (FEV1), maximal expiratory pressure (MEP), and the standardized mean differences for the quality of life and maximum ventilation volume. RESULTS The search found 232 papers, and after the screening, four studies met the inclusion criteria and were included in the meta-analytical procedures (n = 150 participants). No changes were demonstrated in the quality of life domains (general health, physical function, mental health, vitality, social function, emotional problem, and pain) after IMT. The IMT provided a considerable effect over the MIP but not on FEV1 and MEP. Conversely, it was not able to provide changes in any of the quality of life domains. None of the included studies evaluated the IMT effects on the expiratory muscle maximal expiratory pressure. CONCLUSION Evidence from studies shows that inspiratory muscle training improves the MIP; however, this effect does not seem to translate to any change in the quality of life or respiratory function outcomes in individuals with SCI.
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Affiliation(s)
| | - Gerson Cipriano
- Science and Technology in Health Program (PPGCTS), University of Brasília, Brasília, Brazil
- Rehabilitation Sciences Graduate Program (PPGCR), University of Brasília, Brasília, Brasil
- Graduate Program in Human Movement and Rehabilitation of Evangelical (PPGMHR), UniEVANGÉLICA, Anápolis, Brazil
| | | | - Gaspar R Chiappa
- Graduate Program in Human Movement and Rehabilitation of Evangelical (PPGMHR), UniEVANGÉLICA, Anápolis, Brazil
| | - Magno F Formiga
- Master's Program in Physical Therapy and Functioning, Department of Physical Therapy, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Graziella França Bernardelli Cipriano
- Science and Technology in Health Program (PPGCTS), University of Brasília, Brasília, Brazil
- Rehabilitation Sciences Graduate Program (PPGCR), University of Brasília, Brasília, Brasil
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Milani M, Milani JGPO, Cipriano GFB, Cahalin LP, Stein R, Cipriano G. Cardiopulmonary Exercise Testing in Post-COVID-19 Patients: Where Does Exercise Intolerance Come From? Arq Bras Cardiol 2023; 120:e20220150. [PMID: 36888777 DOI: 10.36660/abc.20220150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 10/26/2022] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Post-COVID-19 exercise intolerance is poorly understood. Cardiopulmonary exercise testing (CPET) can identify the underlying exercise limitations. OBJECTIVES To evaluate the source and magnitude of exercise intolerance in post-COVID-19 subjects. METHODS Cohort study assessing subjects with different COVID-19 illness severities and a control group selected by propensity score matching. In a selected sample with CPET prior to viral infection, before and after comparisons were performed. Level of significance was 5% in the entire analysis. RESULTS One hundred forty-four subjects with COVID-19 were assessed (median age: 43.0 years, 57% male), with different illness severities (60% mild, 21% moderate, 19% severe). CPET was performed 11.5 (7.0, 21.2) weeks after disease onset, with exercise limitations being attributed to the peripheral muscle (92%), and the pulmonary (6%), and cardiovascular (2%) systems. Lower median percent-predicted peak oxygen uptake was observed in the severe subgroup (72.2%) as compared to the controls (91.6%). Oxygen uptake differed among illness severities and controls at peak and ventilatory thresholds. Conversely, ventilatory equivalents, oxygen uptake efficiency slope, and peak oxygen pulse were similar. Subgroup analysis of 42 subjects with prior CPET revealed significant reduction in only peak treadmill speed in the mild subgroup and in oxygen uptake at peak and ventilatory thresholds in the moderate/severe subgroup. By contrast, ventilatory equivalents, oxygen uptake efficiency slope, and peak oxygen pulse did not change significantly. CONCLUSIONS Peripheral muscle fatigue was the most common exercise limitation etiology in post-COVID-19 patients regardless of the illness severity. Data suggest that treatment should emphasize comprehensive rehabilitation programs, including aerobic and muscle strengthening components.
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Affiliation(s)
- Mauricio Milani
- Fitcordis Medicina do Exercício , Brasília , DF - Brasil.,Universidade de Brasília - Programa de Pós-Graduação em Ciências e Tecnologias da Saúde , Brasília , DF - Brasil
| | - Juliana Goulart Prata Oliveira Milani
- Fitcordis Medicina do Exercício , Brasília , DF - Brasil.,Universidade de Brasília - Programa de Pós-Graduação em Ciências e Tecnologias da Saúde , Brasília , DF - Brasil
| | - Graziella França Bernardelli Cipriano
- Universidade de Brasília - Programa de Pós-Graduação em Ciências e Tecnologias da Saúde , Brasília , DF - Brasil.,Universidade de Brasília - Programa de Ciências da Reabilitação , Brasília , DF - Brasil
| | - Lawrence Patrick Cahalin
- Department of Physical Therapy , University of Miami , Miller School of Medicine , Florida - EUA
| | - Ricardo Stein
- Universidade Federal do Rio Grande do Sul - Programa de Pós-Graduação em Cardiologia e Ciências Cardiovasculares , Porto Alegre , RS - Brasil
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Rocha LPB, da Rocha Medeiros F, de Oliveira HN, Valduga R, Cipriano G, Cipriano GFB. Analysis of physical function, muscle strength, and pulmonary function in surgical cancer patients: a prospective cohort study. Support Care Cancer 2023; 31:105. [PMID: 36625997 DOI: 10.1007/s00520-022-07507-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 11/17/2022] [Indexed: 01/11/2023]
Abstract
The aim of this study was to investigate mobility, physical functioning, peripheral muscle strength, inspiratory muscle strength and pulmonary function in surgical cancer patients admitted to an intensive care unit (ICU). We conducted a prospective cohort study with 85 patients. Mobility, physical functioning, peripheral muscle strength, inspiratory muscle strength, and pulmonary function were assessed using the following tests: ICU Mobility Scale (IMS); Chelsea Critical Care Physical Assessment (CPAx); handgrip strength and Medical Research Council Sum-Score (MRC-SS); maximal inspiratory pressure (MIP) and S-Index; and peak inspiratory flow, respectively. The assessments were undertaken at ICU admission and discharge. The data were analyzed using the Shapiro-Wilk and Wilcoxon tests and Spearman's correlation coefficient. Significant differences in inspiratory muscle strength, CPAx, grip strength, MRC-SS, MIP, S-Index, and peak inspiratory flow scores were observed between ICU admission and discharge. Grip strength showed a moderate correlation with MIP at admission and discharge. The findings also show a moderate correlation between S-Index scores and both MIP and peak inspiratory flow scores at admission and a strong correlation at discharge. Patients showed a gradual improvement in mobility, physical functioning, peripheral and inspiratory muscle strength, and inspiratory flow during their stay in the ICU.
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Affiliation(s)
- Lara Patrícia Bastos Rocha
- Science of Rehabilitation Program, Physical Therapy Department, University of Brasília, Brasília, DF, Brazil.,Institute of Strategic Health Management of the Federal District Brasília, Brasília, Brazil
| | | | | | - Renato Valduga
- Institute of Strategic Health Management of the Federal District Brasília, Brasília, Brazil
| | - Gerson Cipriano
- Science of Rehabilitation Program, Physical Therapy Department, University of Brasília, Brasília, DF, Brazil.,Science and Technology in Health Program, University of Brasília, DF, Brasília, Brazil
| | - Graziella França Bernardelli Cipriano
- Science of Rehabilitation Program, Physical Therapy Department, University of Brasília, Brasília, DF, Brazil. .,University of Brasília, QNN 14 Área Especial, Ceilândia Sul., DF, CEP: 72220-140, Brasília, Brazil.
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10
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Jardim IDSC, Milani M, Castro I, Hansen D, Karsten M, Cahalin LP, Cipriano GFB, Cipriano G. Impact of COVID-19's on Cardiovascular Rehabilitation Programs in Brazil: An Online Survey-Based Cross-Sectional Study. Arq Bras Cardiol 2023; 120:e20220135. [PMID: 36921154 PMCID: PMC9973047 DOI: 10.36660/abc.20220135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 11/16/2022] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic had an impact on cardiovascular rehabilitation (CR) programs in Brazil. OBJECTIVES To describe the characteristics of CR programs in Brazil, the impacts of the first epidemiological wave of COVID-19 (first 60 days) on the programs and present the initiatives used to overcome the impacts. METHOD This cross-sectional and retrospective study utilized a specific online survey. Participants were coordinators of CR programs. Variables were presented by Brazilian geographic region and as the following categories: demographic, clinical and operational characteristics. The significance level for statistical analysis was set at 5%. RESULTS Fifty-nine CR programs were responsible for 5,349 patients, of which only 1,817 were post-acute cardiovascular events, which corresponded to 1.99% of hospitalized patients in the month prior to the survey (n=91,231). The greatest impact was the suspension of on-site activities, which occurred similarly in areas with the highest and the lowest rates of COVID-19 in the period. Forty-five programs (75%) were shortly interrupted, while three (5%) were ended. All 42 programs that already used remote rehabilitation strategies noticed a substantial increase in activities, based primarily on the use of media and video calling. Only three (5%) considered safe to see patients during the first 60 days. CONCLUSIONS There was a reduction in the number of CR programs with the COVID-19 pandemic. Telerehabilitation activities increased during the first two months of the COVID-19 pandemic, but this was not enough to overcome the reduction in CR program activities across Brazil.
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Affiliation(s)
- Iara de Sousa Cezário Jardim
- Programa de Pós Graduação em Ciências da Reabilitação (PPGCR), Universidade de Brasília (UNB), Brasília, DF - Brasil
| | - Mauricio Milani
- Fitcordis, Brasília, DF - Brasil.,Programa de Pós Graduação em Ciências e Tecnologias em Saúde (PPGCTS), Universidade de Brasília (UNB), Brasília, DF - Brasil
| | - Isac Castro
- Universidade de São Paulo, São Paulo, SP - Brasil
| | | | - Marlus Karsten
- Programa de Pós-graduação em Fisioterapia (PPGFT), Universidade do Estado de Santa Catarina, Florianópolis, SC - Brasil
| | | | | | - Gerson Cipriano
- Programa de Pós Graduação em Ciências da Reabilitação (PPGCR), Universidade de Brasília (UNB), Brasília, DF - Brasil
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11
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Milani M, Milani JGPO, Cipriano G. Encaminhamento de Angina Refratária para Reabilitação Cardiovascular: Um Paciente Negligenciado. Arq Bras Cardiol 2022; 119:754-755. [DOI: 10.36660/abc.20220695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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12
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Oliveira Milani JGP, Milani M, Bernardelli Cipriano GF, Cipriano G. Estimation of the Maximal Heart Rate for Exercise Prescription in Heart Failure patients: are we there yet? Eur J Prev Cardiol 2022; 30:419-421. [PMID: 36239202 DOI: 10.1093/eurjpc/zwac236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/22/2022] [Accepted: 10/10/2022] [Indexed: 11/14/2022]
Affiliation(s)
| | - Mauricio Milani
- Health Sciences and Technologies Graduate Program, University of Brasilia (UnB), Brasilia, DF, Brazil
| | | | - Gerson Cipriano
- Health Sciences and Technologies Graduate Program, University of Brasilia (UnB), Brasilia, DF, Brazil
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13
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Cahalin LP, Formiga MF, Anderson B, Cipriano G, Hernandez ED, Owens J, Hughes L. A call to action for blood flow restriction training in older adults with or susceptible to sarcopenia: A systematic review and meta-analysis. Front Physiol 2022; 13:924614. [PMID: 36045750 PMCID: PMC9421943 DOI: 10.3389/fphys.2022.924614] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background: The extent to which exercise training with blood flow restriction (BFR) improves functional performance (FP) in people with sarcopenia remains unclear. We performed a comprehensive search of BFR training in subjects with sarcopenia or susceptible to sarcopenia hoping to perform a systematic review and meta-analysis on the effects of BFR on FP in older adults without medical disorders, but with or susceptible to sarcopenia.Methods: PubMed and the Cochrane library were searched through February 2022. Inclusion criteria were: 1) the study examined older adults (>55 years of age) with or susceptible to sarcopenia and free of overt acute or chronic diseases, 2) there was a random allocation of participants to BFR and active control groups, 3) BFR was the sole intervention difference between the groups, and 4) the study provided post-intervention measures of skeletal muscle and physical function which were either the same or comparable to those included in the revised European Working Group on Sarcopenia in Older People (EWGSOP) diagnostic algorithm.Results: No studies of BFR training in individuals with sarcopenia were found and no study included individuals with FP values below the EWGSOP criteria. However, four studies of BFR training in older adults in which FP was examined were found. BFR training significantly improved the timed up and go (MD = −0.46, z = 2.43, p = 0.02), 30-s chair stand (MD = 2.78, z = 3.72, p < 0.001), and knee extension strength (standardized MD = 0.5, z = 2.3, p = 0.02) in older adults.Conclusion: No studies of BFR exercise appear to have been performed in patients with or suspected sarcopenia based on latest diagnostic criteria. Despite the absence of such studies, BFR training was found to significantly improve the TUG, 30-s chair stand, and knee extension strength in older adults. Studies examining the effects of BFR in subjects below EWGSOP cut-off points are needed.
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Affiliation(s)
- Lawrence P. Cahalin
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, FL, United States
- *Correspondence: Lawrence P. Cahalin,
| | - Magno F. Formiga
- Departamento de Fisioterapia, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - Brady Anderson
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, FL, United States
| | - Gerson Cipriano
- Departamento de Fisioterapia, Universidade de Brasília, Brasília, DF, Brazil
| | - Edgar D. Hernandez
- Departamento del Movimiento Corporal Humano y sus desórdenes, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Johnny Owens
- Owens Recovery Science, San Antonio, TX, United States
| | - Luke Hughes
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Northumbria, United Kingdom
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14
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Pedon WR, Lima FV, Cipriano G, da Silva WA, Fernandes MVS, Gomes NS, Chiappa AMG, Pena de Sousa R, Pereira da Silva ME, Chiappa GR. Acute hemodynamic responses from Low- load resistance exercise with blood flow restriction in young and older individuals: A Systematic Review and Meta-Analysis of Cross-Over Trials. Clin Physiol Funct Imaging 2022; 42:396-412. [PMID: 35808940 DOI: 10.1111/cpf.12779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/30/2022] [Accepted: 07/05/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To summarize the existing evidence on the acute response of low-load (LL) resistance exercise (RE) with blood flow restriction (BFR) on hemodynamic parameters. DATA SOURCES MEDLINE (via PubMed), EMBASE (via Scopus), SPORTDiscus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Web of Science, and MedRxiv databases were searched from inception to February 2022. REVIEW METHODS Cross-over trials investigating the acute effect of LLRE+BFR vs. passive (no exercise) and active control methods (LLRE or HLRE) on heart rate (HR), systolic (SBP), diastolic (DBP), and mean (MBP) blood pressure responses. RESULTS The quality of the studies was assessed using the PEDro scale, risk of bias using the RoB 2.0 tool for cross-over trials, and certainty of the evidence using the GRADE method. A total of 15 randomized cross-over studies with 466 participants were eligible for analyses. Our data showed that LLRE+BFR increases all hemodynamic parameters compared to passive control, but not compared to conventional resistance exercise. Subgroup analysis did not demonstrate any differences between LLRE+BFR and low- (LL) or high-load (HL) resistance exercise protocols. Studies including younger volunteers presented higher chronotropic responses (HR) than those with older volunteers. CONCLUSIONS Despite causing notable hemodynamic responses compared to no exercise, the short-term low-load resistance exercise with BFR modulates all hemodynamic parameters HR, SBP, DBP, and MBP, similarly to a conventional resistance exercise protocol, whether at low or high-intensity. The chronotropic response is slightly higher in younger healthy individuals despite the similarity regarding pressure parameters. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- William R Pedon
- Graduate Program in Human Movement and Rehabilitation of Evangelical University of Goias, Brazil
| | | | | | - Weder A da Silva
- Graduate Program in Human Movement and Rehabilitation of Evangelical University of Goias, Brazil
| | - Marcos V S Fernandes
- Graduate Program in Human Movement and Rehabilitation of Evangelical University of Goias, Brazil
| | - Natalia S Gomes
- Graduate Program in Human Movement and Rehabilitation of Evangelical University of Goias, Brazil
| | | | - Rafael Pena de Sousa
- Graduate Program in Human Movement and Rehabilitation of Evangelical University of Goias, Brazil
| | | | - Gaspar R Chiappa
- Graduate Program in Human Movement and Rehabilitation of Evangelical University of Goias, Brazil
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15
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Scherrenberg M, Marinus N, Giallauria F, Falter M, Kemps H, Wilhelm M, Prescott E, Vigorito C, De Kluiver E, Cipriano G, Dendale P, Hansen D. The need for long-term personalized management of frail CVD patients by rehabilitation and telemonitoring: a framework. Trends Cardiovasc Med 2022:S1050-1738(22)00023-8. [PMID: 35121082 DOI: 10.1016/j.tcm.2022.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/24/2022] [Accepted: 01/29/2022] [Indexed: 10/19/2022]
Abstract
Due to advances in cardiovascular medicine and preventive cardiology, patients benefit from a better prognosis, even in case of significant disease burden such as acute and chronic coronary syndromes, advanced valvular heart disease and chronic heart failure. These advances have allowed CVD patients to increase their life expectancy, but on the other hand also experience aging-related syndromes such as frailty. Despite being underrecognized, frailty is a critical, common, and co-existent condition among older CVD patients, leading to exercise intolerance and compromised adherence to cardiovascular rehabilitation. Moreover, frail patients need a different approach for CR and are at very high risk for adverse events, but yet are underrepresented in conventional CR. Fortunately, recent advances have been made in technology, allowing remote monitoring, coaching and supervision of CVD patients in secondary prevention programs with promising benefits. Similarly, we hypothesized that such programs should also be implemented to treat frailty in CVD patients. However, considering frail patients' particular needs and challenges, telerehabilitation interventions should thus be appropriately adapted. Our purpose is to provide, for the first time and based on expert opinions, a framework of how such a cardiac telerehabilitation program could be developed and implemented to manage a prevention and rehabilitation program for CVD patients with frailty.
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Affiliation(s)
- Martijn Scherrenberg
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium; UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium; Faculty of Medicine and Health Sciences, Antwerp University, Belgium
| | - Nastasia Marinus
- UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL, Hasselt, Belgium
| | | | - Maarten Falter
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium; UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium; Faculty of Medicine, Department of Cardiology, KULeuven, Herestraat 49, 3000, Leuven, Belgium
| | - Hareld Kemps
- Department of Cardiology, Máxima Medical Center, The Netherlands; Department of Industrial Design, Technical University Eindhoven, The Netherlands
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Eva Prescott
- Department of Cardiology, Bispebjerg University Hospital, University of Copenhagen, Copenhagen, NW, Denmark
| | - Carlo Vigorito
- Department of Translational Medical Sciences, Federico II University of Naples
| | | | | | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium; UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| | - Dominique Hansen
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium; UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL, Hasselt, Belgium.
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16
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Lima ACGB, Formiga MF, Giollo LT, da Silva ML, da Silva VZM, Otto MEB, Chiappa GR, Cipriano G. Arterial stiffness and pulse wave morphology in Chagas heart failure: insights from noninvasive applanation tonometry. J Cardiovasc Med (Hagerstown) 2022; 23:e36-e38. [PMID: 34839319 DOI: 10.2459/jcm.0000000000001287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | | | - Vinicius Z M da Silva
- University of Brasília, Distrito Federal
- University Center of Anapólis (UniEVANGÉLICA), Goiás, Brazil
| | | | - Gaspar R Chiappa
- University of Brasília, Distrito Federal
- University Center of Anapólis (UniEVANGÉLICA), Goiás, Brazil
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17
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Ramalho SHR, Lima ACGBD, Silva FMFD, Souza FSJD, Cahalin LP, Cipriano GFB, Cipriano G. Relação da Função Pulmonar e da Força Inspiratória com Capacidade Aeróbica e com Prognóstico na Insuficiência Cardíaca. Arq Bras Cardiol 2021; 118:680-691. [PMID: 35137780 PMCID: PMC9006999 DOI: 10.36660/abc.20201130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 05/12/2021] [Indexed: 01/12/2023] Open
Abstract
Fundamento A espirometria é subutilizada na insuficiência cardíaca (IC) e não está claro o grau de associação de cada defeito com a capacidade de exercício e com o prognóstico desses pacientes. Objetivo Determinar a relação da %CVF prevista (ppCVF) e do VEF1/CVF contínuos com: 1) pressão inspiratória máxima (PImáx), fração de ejeção do ventrículo esquerdo (FEVE) e desempenho ao exercício; e 2) prognóstico, para o desfecho composto de morte cardiovascular, transplante cardíaco ou implante de dispositivo de assistência ventricular. Métodos Coorte de 111 participantes com IC (estágios AHA C/D) sem pneumopatia; foram submetidos a espirometria, manovacuometria e teste cardiopulmonar máximo. As magnitudes de associação foram verificadas por regressões lineares e de Cox (HR; IC 95%), ajustadas para idade/sexo, e p <0,05 foi considerado significativo. Resultados Com idade média 57±12 anos, 60% eram homens, 64% em NYHAIII. A cada aumento de 10% no VEF1/CVF [β 7% (IC 95%: 3-10)] e no ppCVF [4% (2-6)], foi associado à reserva ventilatória (VRes); no entanto, apenas o ppCVF associado à PImáx [3,8cmH2O (0,3-7,3)], à fração de ejeção do ventrículo esquerdo (FEVE) [2,1% (0,5-3,8)] e ao VO2 pico [0,5mL/kg/min (0,1-1,0)], considerando idade/sexo. Em 2,2 anos (média), ocorreram 22 eventos; tanto FEV1/FVC (HR 1,44; IC 95%: 0,97-2,13) quanto ppCVF (HR 1,13; 0,89-1,43) não foram associados ao desfecho. Apenas no subgrupo FEVE ≤50% (n=87, 20 eventos), VEF1/CVF (HR 1,50; 1,01-2,23), mas não ppCVF, foi associado a risco. Conclusão Na IC crônica, ppCVF reduzido associou-se a menor PImáx, FEVE, VRes e VO2 pico, mas não distinguiu pior prognóstico em 2,2 anos de acompanhamento. Entretanto, VEF1/CVF associou-se apenas com VRes, e, em participantes com FEVE ≤50%, o VEF1/CVF reduzido mostrou pior prognóstico proporcional. Portanto, VEF1/CVF e ppFVC contribuem para melhor fenotipagem de pacientes com IC.
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18
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Turri-Silva N, Vale-Lira A, Verboven K, Quaglioti Durigan JL, Hansen D, Cipriano G. High-intensity interval training versus progressive high-intensity circuit resistance training on endothelial function and cardiorespiratory fitness in heart failure: A preliminary randomized controlled trial. PLoS One 2021; 16:e0257607. [PMID: 34597330 PMCID: PMC8486136 DOI: 10.1371/journal.pone.0257607] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/18/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Exercise training is strongly recommended as a therapeutic approach to treat individuals with heart failure. High-intensity exercise training modalities still controversial in this population. The study aims to preliminary assess the consequences of high-intensity exercise training modalities, aerobic interval training (HIIT) and progressive high circuit-resistance training (CRT), on primarily endothelial function and cardiorespiratory fitness, and secondly on muscle strength and physical performance in heart failure patients. METHODS This preliminary multicentric randomized controlled trial comprised 23 heart failure patients, aged 56 ± 10 years old, mainly New York Heart Association classification I and II (%), hemodynamically stable, who compromise at least 36 exercise sessions of a randomly assigned intervention (HIIT, CRT or control group). Endothelial function, cardiopulmonary exercise testing, muscle strength and physical performance were completed at baseline and post-intervention. RESULTS Although no effects on endothelial function; both HIIT and CRT modalities were able to produce a positive effect on [Formula: see text] peak (HIIT = +2.1±6.5, CRT = +3.0±4.2 and control group = -0.1± 5.3 mL/kg/min, time*group p-value<0,05) and METs (HIIT = +0.6±1.8, CRT = +0.9±1.2 and control group = 0±1.6, time*group p-value<0,05). Only HIIT increased isokinetic torque peak (HIIT = +8.8±55.8, CRT = 0.0±60.7 and control group = 1.6±57.6 Nm) matched p-value<0,05. Regarding the physical performance, the CRT modality reduced chair stand test completion time (HIIT = -0.7±3.1, CRT = -3.3±3.2 and control group = -0.3±2.5 s, matched p-value<0,05 and HIIT improved global physical performance(time*group p<0,05). CONCLUSION This preliminary study trends to indicate for the first time that high-intensity interval training promotes a jointly superior effect compared to progressive high intensity circuit-resistance training by improving cardiorespiratory fitness, muscular strength, and physical performance. Further research with larger cohort is necessary. CLINICAL TRIAL REGISTRATION NUMBER ReBEC RBR-668c8v.
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Affiliation(s)
- Natália Turri-Silva
- Health and Technologies in Health Sciences Program, University of Brasilia, Brasilia, Brazil
- BIOMED-REVAL (Rehabilitation Research Centre), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Amanda Vale-Lira
- Rehabilitation Sciences Program, Faculty of Physical Education, University of Brasília, Brasilia, Brazil
| | - Kenneth Verboven
- BIOMED-REVAL (Rehabilitation Research Centre), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - João Luiz Quaglioti Durigan
- Health and Technologies in Health Sciences Program, University of Brasilia, Brasilia, Brazil
- Rehabilitation Sciences Program, Faculty of Physical Education, University of Brasília, Brasilia, Brazil
| | - Dominique Hansen
- BIOMED-REVAL (Rehabilitation Research Centre), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Physical Therapy Department, University of Brasilia, Brasilia, Brazil
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Gerson Cipriano
- Health and Technologies in Health Sciences Program, University of Brasilia, Brasilia, Brazil
- Rehabilitation Sciences Program, Faculty of Physical Education, University of Brasília, Brasilia, Brazil
- Physical Therapy Department, University of Brasilia, Brasilia, Brazil
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Maldaner V, Coutinho J, Santana ANDC, Cipriano GFB, Oliveira MC, Carrijo MDM, Lino MEM, Cahalin LP, Lima AG, Borges R, Santos DB, Silva IO, Oliveira LVF, Cipriano G. Adjunctive inspiratory muscle training for patients with COVID-19 (COVIDIMT): protocol for randomised controlled double-blind trial. BMJ Open 2021; 11:e049545. [PMID: 34551948 PMCID: PMC8460528 DOI: 10.1136/bmjopen-2021-049545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION A significant number of patients with COVID-19 may experience dyspnoea, anxiety, depression, pain, fatigue and physical impairment symptoms, raising the need for a multidisciplinary rehabilitation approach, especially for those with advanced age, obesity, comorbidities and organ failure. Traditional pulmonary rehabilitation (PR), including exercise training, psychosocial counselling and education, has been employed to improve pulmonary function, exercise capacity and quality of life in patients with COVID-19. However, the effects of inspiratory muscle training (IMT) in PR programmes remain unclear. This study aimed to determine whether the addition of a supervised IMT in a PR is more effective than PR itself in improving dyspnoea, health-related quality of life and exercise capacity in symptomatic patients with post-COVID-19. METHODS AND ANALYSIS This parallel-group, assessor-blinded randomised controlled trial, powered for superiority, aimed to assess exercise capacity as the primary outcome. A total of 138 are being recruited at two PR centres in Brazil. Following baseline testing, participants will be randomised using concealed allocation, to receive either (1) standard PR with sham IMT or (2) standard PR added to IMT. Treatment effects or differences between the outcomes (at baseline, after 8 and 16 weeks, and after 6 months) of the study groups will be analysed using an ordinary two-way analysis of variance. ETHICS AND DISSEMINATION This trial was approved by the Brazilian National Ethics Committee and obtained approval on 7 October 2020 (document number 4324069). The findings will be disseminated through publications in peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER NCT04595097.
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Affiliation(s)
- Vinicius Maldaner
- Physical Therapy Department, UniEVANGELICA University, Anapolis, Brazil
- Human Movement and Rehabilitation Program, UniEVANGELICA University, Anapolis, Brazil
| | - Jean Coutinho
- Human Movement and Rehabilitation Program, UniEVANGELICA University, Anapolis, Brazil
| | | | - Graziella F B Cipriano
- Rehabilitation Sciences and Health and Technologies in Health Sciences Program, University of Brasilia, Brasilia, Brazil
| | | | | | - Maria Eduarda M Lino
- Human Movement and Rehabilitation Program, UniEVANGELICA University, Anapolis, Brazil
| | - Lawrence P Cahalin
- Physical Therapy, University of Miami School of Medicine, Miami, Florida, USA
| | | | - Robson Borges
- Rehabilitation Sciences and Health and Technologies in Health Sciences Program, University of Brasilia, Brasilia, Brazil
| | - Dante Brasil Santos
- Human Movement and Rehabilitation Program, UniEVANGELICA University, Anapolis, Brazil
| | - Iransé Oliveira Silva
- Human Movement and Rehabilitation Program, UniEVANGELICA University, Anapolis, Brazil
- Physical Education, UniEVANGELICA University, Anapolis, Brazil
| | - Luis Vicente Franco Oliveira
- Physical Therapy Department, UniEVANGELICA University, Anapolis, Brazil
- Human Movement and Rehabilitation Program, UniEVANGELICA University, Anapolis, Brazil
| | - Gerson Cipriano
- Rehabilitation Sciences and Health and Technologies in Health Sciences Program, University of Brasilia, Brasilia, Brazil
- Health Sciences and Technologies, University of Brasilia, Brasilia, Brazil
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Amatuzzi F, Gervazoni Balbuena de Lima AC, Da Silva ML, Cipriano GFB, Catai AM, Cahalin LP, Chiappa G, Cipriano G. Acute and Time-Course Effects of Osteopathic Manipulative Treatment on Vascular and Autonomic Function in Patients With Heart Failure: A Randomized Trial. J Manipulative Physiol Ther 2021; 44:455-466. [PMID: 34456043 DOI: 10.1016/j.jmpt.2021.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/19/2020] [Accepted: 06/15/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The purposed of this study was to valuate the effect of osteopathic manipulative treatment (OMT) on flow-mediated dilation and heart rate variability of patients with heart failure. BACKGROUND Osteopathic manipulative treatment modulates both the vascular and autonomic nervous system (ANS) in healthy volunteers. However, the acute and time-course effects of the OMT on patients with an overactive ANS remain unclear. METHODS This randomized controlled trial study included 20 patients with heart failure aged 50 to 60 years, allocated to a single session of OMT (base of the skull, retromaxillary region, heart, and thoracic duct) or sham. Flow-mediated dilation (FMD) at the brachial artery, hemodynamic measures, and heart rate variability were assessed in 3 periods (baseline, immediately after the intervention, and after 15 minutes). Multivariate analysis of variance procedure was used to compare intervention and periods. RESULTS The OMT group had a greater FMD modulation compared with the sham (FMD,% = 9.5 vs. -5.6, 95% confidence interval (CI): [6.6, -12.35] vs. [-14.25, 2.8]; p = 0.001) and grater peak diameter (PD, mm = 0.77 vs -0.16 mm, 95% CI: [0.31,-1.24] vs [-0.63, 0.29]; P = 0.001), suggesting an important acute and time-course vascular effect from OMT. We also found some relevant heart rate variability modulation after 15 minutes from OMT: high frequency (HF, ms2 = 295 vs -354, 95% CI: [144.2, -769]; P = .001) and low frequency (LF, ms2) = 670 vs 775, 95% CI: [-98, 3591]; P = .001), suggesting a time-course ANS modulation after OMT. CONCLUSIONS Osteopathic manipulative treatment was effective at increasing brachial blood flow and stimulating the vagal system in patients with heart failure. Moreover, vascular changes seem to precede the autonomic modulation.
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Affiliation(s)
| | | | | | | | - Aparecida Maria Catai
- Physical Therapy Department, Federal University of São Carlos, São Carlos, SP, Brazil
| | | | - Gaspar Chiappa
- Centro Universitário de Anápolis, Anápolis, Anápolis, GO, Brazil
| | - Gerson Cipriano
- Health Sciences and Technology Program, University of Brasília, Brasília, DF, Brazil
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21
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Borges RF, Chiappa GR, Muller PT, de Lima ACGB, Cahalin LP, Cipriano GFB, Cipriano G. Moderate-intensity exercise with blood flow restriction on cardiopulmonary kinetics and efficiency during a subsequent high-intensity exercise in young women: A cross-sectional study. Medicine (Baltimore) 2021; 100:e25368. [PMID: 34397788 PMCID: PMC8341275 DOI: 10.1097/md.0000000000025368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/10/2021] [Indexed: 01/04/2023] Open
Abstract
Blood flow restriction (BFR) training applied prior to a subsequent exercise has been used as a method to induce changes in oxygen uptake pulmonary kinetics (O2P) and exercise performance. However, the effects of a moderate-intensity training associated with BFR on a subsequent high-intensity exercise on O2P and cardiac output (QT) kinetics, exercise tolerance, and efficiency remain unknown.This prospective physiologic study was performed at the Exercise Physiology Lab, University of Brasilia. Ten healthy females (mean ± SD values: age = 21.3 ± 2.2 years; height = 1.6 ± 0.07 m, and weight = 55.6 ± 8.8 kg) underwent moderate-intensity training associated with or without BFR for 6 minutes prior to a maximal high-intensity exercise bout. O2P, heart rate, and QT kinetics and gross efficiency were obtained during the high-intensity constant workload exercise test.No differences were observed in O2P, heart rate, and QT kinetics in the subsequent high-intensity exercise following BFR training. However, exercise tolerance and gross efficiency were significantly greater after BFR (220 ± 45 vs 136 ± 30 seconds; P < .05, and 32.8 ± 6.3 vs 27.1 ± 5.4%; P < .05, respectively), which also resulted in lower oxygen cost (1382 ± 227 vs 1695 ± 305 mL min-1).We concluded that moderate-intensity BFR training implemented prior to a high-intensity protocol did not accelerate subsequent O2P and QT kinetics, but it has the potential to improve both exercise tolerance and work efficiency at high workloads.
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Affiliation(s)
- Robson F. Borges
- Physical Education Graduate Program, University of Brasilia (UnB), Brasilia, DF, Brazil
| | - Gaspar R. Chiappa
- Graduate Program in Human Movement and Rehabilitation of Evangelical University of Goiás, Brazil
| | - Paulo T. Muller
- Laboratory of Respiratory Pathophysiology (LAFIR), Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | | | | | - Graziella França Bernardelli Cipriano
- Health Sciences and Technologies Graduate Program, University of Brasilia (UnB), Brasilia, DF, Brazil
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, FL
| | - Gerson Cipriano
- Physical Education Graduate Program, University of Brasilia (UnB), Brasilia, DF, Brazil
- Health Sciences and Technologies Graduate Program, University of Brasilia (UnB), Brasilia, DF, Brazil
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, FL
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22
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Ricci P, Sion L, Capezzuto F, Cipriano G, D'Onghia G, Libralato S, Maiorano P, Tursi A, Carlucci R. Dataset and species aggregation method applied to food-web models in the Northern Ionian Sea (Central Mediterranean Sea). Data Brief 2021; 36:106964. [PMID: 33869693 PMCID: PMC8040120 DOI: 10.1016/j.dib.2021.106964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/15/2021] [Accepted: 03/11/2021] [Indexed: 11/30/2022] Open
Abstract
The ecological roles of the species in the food web are studied through the Ecopath with Ecosim modelling approach. In this modelling approach, the food web is described by means of functional groups, each representing a species, a life stage of a species, or a group of species with similar trophic, ecological and physiological features. Links between the groups are formally described by a set of linear equations, informed with ecological and fishing data. Here, the data input collected to implement 3 Ecopath models in the Northern Ionian Sea (Central Mediterranean Sea) from 1995 to 2015 are reported. This dataset applied to study the ecological roles of the demersal Chondrichthyes in the study area could be useful to explore different fishing management scenarios. A large dataset of over 300 taxa is shown detailing the ecological inputs, such as Biomass (kg km-2), Production and Consumption rates (y-1), Diet information (weight in %), and fishing data represented by Landings and Discards (t km-2 y-1). In particular, the fishery data described the catches of trawls, longlines, passive nets, other gears and purse seine. In addition, a description of the aggregation method of the species is shown.
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Affiliation(s)
- P. Ricci
- Department of Biology, University of Bari Aldo Moro, Via Orabona, 4, 70125 Bari, Italy
- CoNISMa, Piazzale Flaminio, 9, 00196 Roma, Italy
| | - L. Sion
- Department of Biology, University of Bari Aldo Moro, Via Orabona, 4, 70125 Bari, Italy
- CoNISMa, Piazzale Flaminio, 9, 00196 Roma, Italy
| | - F. Capezzuto
- Department of Biology, University of Bari Aldo Moro, Via Orabona, 4, 70125 Bari, Italy
- CoNISMa, Piazzale Flaminio, 9, 00196 Roma, Italy
| | - G. Cipriano
- Department of Biology, University of Bari Aldo Moro, Via Orabona, 4, 70125 Bari, Italy
- CoNISMa, Piazzale Flaminio, 9, 00196 Roma, Italy
| | - G. D'Onghia
- Department of Biology, University of Bari Aldo Moro, Via Orabona, 4, 70125 Bari, Italy
- CoNISMa, Piazzale Flaminio, 9, 00196 Roma, Italy
| | - S. Libralato
- National Institute of Oceanography and Applied Geophysics – OGS, Borgo Grotta Gigante 42/c, 34010 Sgonico, Trieste, Italy
| | - P. Maiorano
- Department of Biology, University of Bari Aldo Moro, Via Orabona, 4, 70125 Bari, Italy
- CoNISMa, Piazzale Flaminio, 9, 00196 Roma, Italy
| | - A. Tursi
- Department of Biology, University of Bari Aldo Moro, Via Orabona, 4, 70125 Bari, Italy
- CoNISMa, Piazzale Flaminio, 9, 00196 Roma, Italy
| | - R. Carlucci
- Department of Biology, University of Bari Aldo Moro, Via Orabona, 4, 70125 Bari, Italy
- CoNISMa, Piazzale Flaminio, 9, 00196 Roma, Italy
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23
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Ricci P, Sion L, Capezzuto F, Cipriano G, D'Onghia G, Libralato S, Maiorano P, Tursi A, Carlucci R. Modelling the trophic roles of the demersal Chondrichthyes in the Northern Ionian Sea (Central Mediterranean Sea). Ecol Modell 2021. [DOI: 10.1016/j.ecolmodel.2021.109468] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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24
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da Silva FMF, Cipriano G, Lima ACGB, Andrade JML, Nakano EY, Chiappa GR, Cahalin LP, Cipriano GFB. Maximal Dynamic Inspiratory Pressure Evaluation in Heart Failure: A Comprehensive Reliability and Agreement Study. Phys Ther 2020; 100:2246-2253. [PMID: 32941640 DOI: 10.1093/ptj/pzaa165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 04/26/2020] [Accepted: 08/11/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The purpose of this study was to analyze the reliability (interrater and intrarater) and agreement (repeatability and reproducibility) properties of tapered flow resistive loading (TFRL) measures in patients with heart failure (HF). METHODS For this cross-sectional study, participants were recruited from the cardiopulmonary rehabilitation program at the University of Brasilia from July 2015 to July 2016. All patients participated in the study, and 10 were randomly chosen for intrarater and interrater reliability testing. The 124 participants with HF (75% men) were 57.6 (SD = 1.81) years old and had a mean left ventricular ejection fraction of 38.9% (SD = 15%) and a peak oxygen consumption of 13.05 (SD = 5.3) mL·kg·min-1. The main outcome measures were the maximal inspiratory pressure (MIP) measured with a standard manovacuometer (SM) and the MIP and maximal dynamic inspiratory pressure (S-Index) obtained with TFRL. The S-Index reliability (interrater and intrarater) was examined by 2 evaluators, the S-Index repeatability was examined with 10 repetitions, and the reproducibility of the MIP and S-Index was measured with SM and TFRL, respectively. RESULTS The reliability analysis revealed high S-Index interrater and intrarater reliability values (intraclass correlation coefficients [ICCs] of 0.89 [95% CI = 0.58-0.98] and 0.97 [95% CI = 0.89-0.99], respectively). Repeatability analyses revealed that 8 maneuvers were required to reach the maximum S-Index in 75.81% (95% CI = 68.27-83.34) of the population. The reproducibility of TFRL measures (S-Index = 68.8 [SD = 32.8] cm H2O; MIP = 66 [SD = 32.3] cm H2O) was slightly lower than that of the SM measurement (MIP = 70.1 [SD = 35.9] cm H2O). CONCLUSIONS The TFRL device provided a reliable intrarater and interrater S-Index measure in patients with HF and had acceptable repeatability, requiring 8 maneuvers to produce a stable S-Index measure. The reproducibilities of the S-Index, MIP obtained with SM, and MIP obtained with TRFL were similar. IMPACT TRFL is a feasible method to assess both MIP and the S-index as measures of inspiratory muscle strength in patients with HF and can be used for inspiratory muscle training, making the combined testing and training capabilities important in both clinical research and the management of patients with HF.
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Affiliation(s)
- Fabiola M F da Silva
- Science and Technology in Health Program, University of Brasília, Brasília, Brazil
| | - Gerson Cipriano
- Science and Technology in Health Program and Physical Therapy Department, Science of Rehabilitation Program, University of Brasília
| | | | | | | | - Gaspar R Chiappa
- Respiratory and Pathology Laboratory, Federal University of Mato Grosso do Sul, Mato Grosso do Sul, Brazil
| | - Lawrence P Cahalin
- Physical Therapy Department and Leonard M. Miller School of Medicine, University of Miami, Coral Gables, Florida
| | - Graziella F B Cipriano
- Science and Technology in Health Program and Physical Therapy Department, Science of Rehabilitation Program, University of Brasília, QNN 14 Área Especial, Ceilândia Sul, CEP 72220-140, Brasília, Brazil
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25
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Turri-Silva N, Ricci-Vitor AL, Cipriano G, Garner D, Netto J, Giacon T, Destro Christofaro DG, Marques Vanderlei LC. Functional Resistance Training Superiority Over Conventional Training in Metabolic Syndrome: A Randomized Clinical Trial. Res Q Exerc Sport 2020; 91:415-424. [PMID: 31906814 DOI: 10.1080/02701367.2019.1679333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 10/07/2019] [Indexed: 06/10/2023]
Abstract
Metabolic syndrome (MetS) is a growing epidemic related with higher values of blood pressure (BP) and autonomic dysfunction. Scientific evidence has been indicating that functional resistance training (FRT) is superior over conventional (CRT) for muscle fatigue and pain, yet its effects on autonomic modulation (AM), BP and heart rate in MetS are unclear. We theorized that FRT can be superior to CRT in MetS patients because of larger muscle activation. This study compares FRT and CRT on AM, blood pressure, heart rate and muscle strength. Thirty-eight sex and age matched individuals (40 to 60 years) were randomized for FRT or CRT, with training intensity varying gradually from 30%-100% of one maximal repetition test (1MR), 3 times/week for 30 sessions. All outcomes were evaluated at baseline and post training. AM was assessed by heart rate variability (mean RR, RMSSD, SDNN, LF, HF, TINN, RRtri, SD1 and SD2). BP (mmHg) was obtained by cuff measures. Muscle strength was assessed by 1MR. An increase in cardiac parasympathetic activity was observed in individuals allocated to FRT in comparison to CRT group (RMSSD ∆40%; SD1 ∆39%; and HF ms 2 ∆80%). Moreover, just FRT was capable of reducing BP post intervention (SBP from 129.21 ± 19.02 to 118.94 ± 14.14 mmHg, p < .009,/d/ = 0.49; DBP from 85.26 ± 11.48 to 77.76 ± 8.93 mmHg, p < .01,/d/ = 0.51). Both groups had a similar increase in muscle strength and no changes between HR. Progressive FRT was more beneficial to CRT regarding AM, increasing vagal activity, and reducing blood pressure in MetS individuals.
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26
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Vieira L, Rocha LPB, Mathur S, Santana L, Melo PFD, Silva VZMD, Durigan JLQ, Cipriano G. Reliability of skeletal muscle ultrasound in critically ill trauma patients. Rev Bras Ter Intensiva 2020; 31:464-473. [PMID: 31967220 PMCID: PMC7008982 DOI: 10.5935/0103-507x.20190072] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 04/15/2019] [Indexed: 12/14/2022] Open
Abstract
Objective To evaluate the safety and feasibility of the ultrasound assessment of quadriceps in the emergency setting. To assess the intra- and interrater reliability for the acquisition and analysis of ultrasound images of muscle thickness and echogenicity in critically ill trauma patients between health professionals with different levels of expertise. Methods Diagnostic accuracy study. Two examiners (expert and novice) acquired ultrasound images from ten patients; an experienced, blinded analyst quantified the images. In a separate group of ten patients, two analysts (expert and novice) quantified quadriceps muscle thickness and echogenicity (square or trace method) from images acquired by one examiner. Results Excellent reliability was found for image acquisition and analysis (intraclass correlation coefficients > 0.987; p < 0.001). The standard error of the measurement values ranged from 0.01 - 0.06cm for muscle thickness and from 0.75 - 2.04 arbitrary units for muscle echogenicity. The coefficients of variation were < 6% for thickness and echogenicity. The echogenicity values were higher when using the square technique than when using the tracing technique (p = 0.003). Conclusion Ultrasound is safe, feasible, and reliable for muscle assessment in critically ill trauma patients, regardless of the assessor's level of expertise.
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Affiliation(s)
- Luciana Vieira
- Programa de Pós-Graduação em Ciências e Tecnologias em Saúde, Universidade de Brasília - Brasília (DF), Brasil.,Departamento de Fisioterapia, Hospital de Base do Distrito Federal - Brasília (DF), Brasil
| | - Lara Patrícia Bastos Rocha
- Programa de Pós-Graduação em Ciências e Tecnologias em Saúde, Universidade de Brasília - Brasília (DF), Brasil.,Unidade de Terapia Intensiva, Hospital de Base do Distrito Federal - Brasília (DF), Brasil
| | - Sunita Mathur
- Departamento de Fisioterapia, Universidade de Toronto - Toronto, Ontario, Canadá
| | - Larissa Santana
- Departamento de Fisioterapia, Universidade de Toronto - Toronto, Ontario, Canadá
| | - Priscilla Flávia de Melo
- Programa de Pós-Graduação em Ciências e Tecnologias em Saúde, Universidade de Brasília - Brasília (DF), Brasil
| | | | - João Luiz Quaglioti Durigan
- Programa de Pós-Graduação em Ciências e Tecnologias em Saúde, Universidade de Brasília - Brasília (DF), Brasil
| | - Gerson Cipriano
- Programa de Pós-Graduação em Ciências e Tecnologias em Saúde, Universidade de Brasília - Brasília (DF), Brasil.,Programa de Pós-Graduação em Ciências da Reabilitação, Departamento de Fisioterapia, Universidade de Brasília - Brasília (DF), Brasil
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27
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Cipriano GF, Cipriano G, Santos FV, Güntzel Chiappa AM, Pires L, Cahalin LP, Chiappa GR. Current insights of inspiratory muscle training on the cardiovascular system: a systematic review with meta-analysis. Integr Blood Press Control 2019; 12:1-11. [PMID: 31190975 PMCID: PMC6535083 DOI: 10.2147/ibpc.s159386] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 04/26/2019] [Indexed: 12/24/2022] Open
Abstract
Background: Cardiorespiratory limitation is a common hallmark of cardiovascular disease which is a key component of pharmacological and exercise treatments. More recently, inspiratory muscle training (IMT) is becoming an effective complementary treatment with positive effects on muscle strength and exercise capacity. We assessed the effectiveness of IMT on the cardiovascular system through autonomic function modulation via heart rate variability and arterial blood pressure. Methods: Randomized controlled trials (RCTs) were identified from searches of The Cochrane Library, MEDLINE and EMBASE to November 2018. Citations, conference proceedings and previous reviews were included without population restriction, comparing IMT intervention to no treatment, placebo or active control. Results: We identified 10 RCTs involving 267 subjects (mean age range 51–71 years). IMT programs targeted maximum inspiratory pressure (MIP) and cardiovascular outcomes, using low (n=6) and moderate to high intensity (n=4) protocols, but the protocols varied considerably (duration: 1–12 weeks, frequency: 3–14 times/week, time: 10–30 mins). An overall increase of the MIP (cmH2O) was observed (−27.57 95% CI −18.48, −37.45, I2=64%), according to weighted mean difference (95%CI), and was accompanied by a reduction of the low to high frequency ratio (−0.72 95% CI−1.40, −0.05, I2=50%). In a subgroup analysis, low- and moderate-intensity IMT treatment was associated with a reduction of the heart rate (HR) (−7.59 95% CI −13.96, −1.22 bpm, I2=0%) and diastolic blood pressure (DBP) (−8.29 [−11.64, −4.94 mmHg], I2=0%), respectively. Conclusion: IMT is an effective treatment for inspiratory muscle weakness in several populations and could be considered as a complementary treatment to improve the cardiovascular system, mainly HR and DBP. Further research is required to better understand the above findings.
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Affiliation(s)
- Graziella Fb Cipriano
- Physical Therapy Department, University of Brasilia, Brasilia, Brazil.,Department of Physical Therapy, University of Miami Miller School Of Medicine, Coral Gables, FL, USA
| | - Gerson Cipriano
- Physical Therapy Department, University of Brasilia, Brasilia, Brazil.,Department of Physical Therapy, University of Miami Miller School Of Medicine, Coral Gables, FL, USA
| | - Francisco V Santos
- Physical Therapy Department, University of Brasilia, Brasilia, Brazil.,Department of Education and Training in Oncology, Cancer Institute of São Paulo, São Paulo, Brazil
| | | | - Luigi Pires
- Centro Universitário do Planalto Central Professor Apparecido dos Santos, Brasilia, Brazil
| | - Lawrence Patrick Cahalin
- Department of Physical Therapy, University of Miami Miller School Of Medicine, Coral Gables, FL, USA
| | - Gaspar R Chiappa
- Centro Universitário do Planalto Central Professor Apparecido dos Santos, Brasilia, Brazil.,University Center, UniEvangelica, Anapolis, Goias, Brazil
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Renò V, Dimauro G, Labate G, Stella E, Fanizza C, Cipriano G, Carlucci R, Maglietta R. A SIFT-based software system for the photo-identification of the Risso's dolphin. ECOL INFORM 2019. [DOI: 10.1016/j.ecoinf.2019.01.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Santos FV, Chiappa GR, Ramalho SHR, de Lima ACGB, de Souza FSJ, Cahalin LP, Durigan JLQ, de Castro I, Cipriano G. Resistance exercise enhances oxygen uptake without worsening cardiac function in patients with systolic heart failure: a systematic review and meta-analysis. Heart Fail Rev 2019; 23:73-89. [PMID: 29199385 DOI: 10.1007/s10741-017-9658-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Recent literature suggests that resistance training (RT) improves peak oxygen uptake ([Formula: see text] peak), similarly to aerobic exercise (AE) in patients with heart failure (HF), but its effect on cardiac remodeling is controversial. Thus, we examined the effects of RT and AE on [Formula: see text] peak and cardiac remodeling in patients with heart failure (HF) via a systematic review and meta-analysis. MEDLINE, EMBASE, Cochrane Library and CINAHL, AMEDEO and PEDro databases search were extracted study characteristics, exercise type, and ventricular outcomes. The main outcomes were [Formula: see text] peak (ml kg-1 min-1), LVEF (%) and LVEDV (mL). Fifty-nine RCTs were included. RT produced a greater increase in [Formula: see text] peak (3.57 ml kg-1 min-1, P < 0.00001, I 2 = 0%) compared to AE (2.63 ml kg-1 min-1, P < 0.00001, I 2 = 58%) while combined RT and AE produced a 2.48 ml kg-1 min-1 increase in [Formula: see text]; I 2 = 69%) compared to control group. Comparison among the three forms of exercise revealed similar effects on [Formula: see text] peak (P = 0.84 and 1.00, respectively; I 2 = 0%). AE was associated with a greater gain in LVEF (3.15%; P < 0.00001, I 2 = 17%) compared to RT alone or combined exercise which produced similar gains compared to control groups. Subgroup analysis revealed that AE reduced LVEDV (- 10.21 ml; P = 0.007, I 2 = 0%), while RT and combined RT and AE had no effect on LVEDV compared with control participants. RT results in a greater gain in [Formula: see text] peak, and induces no deleterious effects on cardiac function in HF patients.
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Affiliation(s)
- Francisco V Santos
- Health Sciences and Technology and Rehabilitation Sciencies Program, University of Brasilia, Centro Metropolitano, Conjunto A - Lote 01 - Ceilândia, Brasília, DF, 72220-900, Brazil
- Cancer Institute of Sao Paulo, Sao Paulo, Brazil
| | - Gaspar R Chiappa
- Health Sciences and Technology and Rehabilitation Sciencies Program, University of Brasilia, Centro Metropolitano, Conjunto A - Lote 01 - Ceilândia, Brasília, DF, 72220-900, Brazil
| | - Sergio Henrique Rodolpho Ramalho
- Health Sciences and Technology and Rehabilitation Sciencies Program, University of Brasilia, Centro Metropolitano, Conjunto A - Lote 01 - Ceilândia, Brasília, DF, 72220-900, Brazil
- Sarah Network of Rehabilitation Hospitals, Brasilia, Brazil
| | - Alexandra Correa Gervazoni Balbuena de Lima
- Health Sciences and Technology and Rehabilitation Sciencies Program, University of Brasilia, Centro Metropolitano, Conjunto A - Lote 01 - Ceilândia, Brasília, DF, 72220-900, Brazil
| | - Fausto Stauffer Junqueira de Souza
- Health Sciences and Technology and Rehabilitation Sciencies Program, University of Brasilia, Centro Metropolitano, Conjunto A - Lote 01 - Ceilândia, Brasília, DF, 72220-900, Brazil
| | - Lawrence P Cahalin
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, FL, USA
| | - João Luiz Quagliotti Durigan
- Health Sciences and Technology and Rehabilitation Sciencies Program, University of Brasilia, Centro Metropolitano, Conjunto A - Lote 01 - Ceilândia, Brasília, DF, 72220-900, Brazil
| | - Isac de Castro
- Department of Medicine, Division of Molecular Medicine, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Gerson Cipriano
- Health Sciences and Technology and Rehabilitation Sciencies Program, University of Brasilia, Centro Metropolitano, Conjunto A - Lote 01 - Ceilândia, Brasília, DF, 72220-900, Brazil.
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Phadke CP, Vierira L, Mathur S, Cipriano G, Ismail F, Boulias C. Impact of Passive Leg Cycling in Persons With Spinal Cord Injury: A Systematic Review. Top Spinal Cord Inj Rehabil 2018; 25:83-96. [PMID: 30774292 DOI: 10.1310/sci18-00020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background: Passive leg cycling is an important clinical tool available for rehabilitation after spinal cord injury (SCI). Passive cycling can be used to derive exercise-related benefits in patients with poor motor control. There have been a number of studies examining the effects of passive cycling on a variety of outcomes. There is need for a systematic assessment of the cycling parameters and the associated clinical changes in cardiovascular, neuromuscular, and musculoskeletal outcomes after passive cycling. Objectives: To assess the effectiveness of passive leg cycling interventions on cardiovascular, neuromuscular, and musculoskeletal outcomes post SCI, and to describe intensity, duration, and type of passive leg cycling post SCI. Methods: PRISMA guided systematic review of literature based on searches in the following databases: PubMed/MEDLINE, PEDro, EMBASE, Cochrane Library, and Google Scholar. Peer-reviewed publications that were written in English were included if they described the effects of a single session or multiple sessions of passive leg cycling in persons post SCI. Results: Eleven papers were included: two were randomized controlled trials (RCTs), one was a crossover trial, and the rest were pre-post single-group designs. Three studies (including two RCTs) reported statistically significant benefits of multiple sessions of passive cycling on leg blood flow velocity, spasticity, reflex excitability and joint range of motion, and markers of muscle hypertrophy. About half of the single session studies showed statistically significant improvement in acute responses. Conclusion: Multiple sessions of passive leg cycling showed benefits in three categories - cardiovascular, musculoskeletal, and neurological - with medium to large effect sizes.
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Affiliation(s)
- Chetan P Phadke
- Spasticity Research Program, West Park Healthcare Centre, Toronto, Ontario, Canada.,Faculty of Health, York University, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Luciana Vierira
- Health Sciences and Technologies PhD Program, University of Brasilia, Brasilia, Brazil
| | - Sunita Mathur
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Gerson Cipriano
- Division of Physical Therapy - Ceilandia College, University of Brasilia, Brasilia, Brazil
| | - Farooq Ismail
- Spasticity Research Program, West Park Healthcare Centre, Toronto, Ontario, Canada.,Division of Physiatry, University of Toronto, Toronto, Ontario, Canada
| | - Chris Boulias
- Spasticity Research Program, West Park Healthcare Centre, Toronto, Ontario, Canada.,Division of Physiatry, University of Toronto, Toronto, Ontario, Canada
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31
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Silva PE, Maldaner V, Vieira L, de Carvalho KL, Gomes H, Melo P, Babault N, Cipriano G, Durigan JLQ. Corrigendum to "Neuromuscular electrophysiological disorders and muscle atrophy in mechanically-ventilated traumatic brain injury patients: New insights from a prospective observational study" [J Crit Care 44 (2018) 87-94]. J Crit Care 2018; 50:316. [PMID: 30503051 DOI: 10.1016/j.jcrc.2018.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Paulo Eugênio Silva
- Physical Therapy Division, University Hospital of Brasília, University of Brasilia, Brasília, DF, Brazil; Health Sciences and Technologies PhD Program, University of Brasilia, DF, Brazil; Physical Therapy Division, Hospital de Base do Distrito Federal, Brasilia, DF, Brazil.
| | - Vinicius Maldaner
- Physical Therapy Division, Hospital de Base do Distrito Federal, Brasilia, DF, Brazil; Health Science School, Health Science Master Program, Brasilia, DF, Brazil
| | - Luciana Vieira
- Health Sciences and Technologies PhD Program, University of Brasilia, DF, Brazil; Clinical Research Center, Hospital de Base do Distrito Federal, Brasilia, DF, Brazil
| | | | - Hedian Gomes
- Physical Therapy Division, Fisioterapia Integrada de Brasília, Brasília, DF, Brazil
| | - Priscilla Melo
- Health Sciences and Technologies PhD Program, University of Brasilia, DF, Brazil; Physical Therapy Division, Hospital de Base do Distrito Federal, Brasilia, DF, Brazil
| | - Nicolas Babault
- INSERM-U1093 Cognition Action et Plasticité Senorimotrice; UFR STAPS, Université de Bourgogne-Franche-Comté, Dijon, France
| | - Gerson Cipriano
- Physical Therapy Division, University of Brasilia, Brasília, DF, Brazil
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Dos Santos FV, Cipriano G, Vieira L, Güntzel Chiappa AM, Cipriano GBF, Vieira P, Zago JG, Castilhos M, da Silva ML, Chiappa GR. Neuromuscular electrical stimulation combined with exercise decreases duration of mechanical ventilation in ICU patients: A randomized controlled trial. Physiother Theory Pract 2018; 36:580-588. [PMID: 30321084 DOI: 10.1080/09593985.2018.1490363] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Early mobilization can be employed to minimize the duration of intensive care. However, a protocol combining neuromuscular electrical stimulation (NMES) with early mobilization has not yet been tested in ICU patients. Our aim was to assess the efficacy of NMES, exercise (EX), and combined therapy (NMES + EX) on duration of mechanical ventilation (MV) in critically ill patients. METHODS The participants in this randomized double-blind trial were prospectively recruited within 24 hours following admission to the intensive care unit of a tertiary hospital. Eligible patients had 18 years of age or older; MV for less than 72 hours; and no known neuromuscular disease. Computer-generated permuted block randomization was used to assign patients to NMES, EX, NMES + EX, or standard care (control group). The main endpoint was duration of MV. Clinical characteristics were also evaluated and intention to treat analysis was employed. RESULTS One hundred forty-four patients were assessed for eligibility to participate in the trial, 51 of whom were enrolled and randomly allocated into four groups: 11 patients in the NMES group, 13 in the EX group, 12 in the NMES + EX group, and 15 in the control group (CG). Duration of MV (days) was significantly shorter in the combined therapy (5.7 ± 1.1) and NMEN (9.0 ± 7.0) groups in comparison to CG (14.8 ± 5.4). CONCLUSIONS NMES + EX consisting of NMES and active EXs was well tolerated and resulted in shorter duration of MV in comparison to standard care or isolated therapy (NMES or EX alone).
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Affiliation(s)
- Francisco Valdez Dos Santos
- Physical Therapy Department, University of Brasilia , Brasilia, Brazil.,Cancer Institute of São Paulo, São Paulo , Brazil
| | - Gerson Cipriano
- Physical Therapy Department, University of Brasilia , Brasilia, Brazil
| | - Luciana Vieira
- Physical Therapy Department, University of Brasilia , Brasilia, Brazil.,Clinical Research Center, Hospital de Base do Distrito Federal , Brasilia, Brazil
| | | | | | - Paulo Vieira
- Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Julio G Zago
- Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | | | | | - Gaspar R Chiappa
- Physical Therapy Department, University of Brasilia , Brasilia, Brazil.,Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil.,Centro Universitário do Planalto Central Professor Apparecido dos Santos , Brasilia, Brazil
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33
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Nakata C, Lima Sánchez A, Santos K, Teixeira F, Cipriano G. ACUTE EFFECTS OF GANGLION ELECTRICAL STIMULATION ON AUTONOMIC MODULATION AND ENDOTHELIAL FUNCTION IN HEART FAILURE PATIENTS WITH CHAGAS DISEASE: A CONTROLLED AND RANDOMIZED STUDY. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Ramalho SH, Cipriano G, Vieira PJ, Winkelmann ER, Callegaro CC, Chiappa GR. Inspiratory Muscle Strength and Six-minute Walking Distance in Heart Failure: Prognostic Utility in a 10 Years Follow up Cohort Study. J Card Fail 2018. [DOI: 10.1016/j.cardfail.2018.07.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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35
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Silva VZMD, Araújo JAD, Cipriano G, Pinedo M, Needham DM, Zanni JM, Guimarães FS. Brazilian version of the Functional Status Score for the ICU: translation and cross-cultural adaptation. Rev Bras Ter Intensiva 2018; 29:34-38. [PMID: 28444070 PMCID: PMC5385983 DOI: 10.5935/0103-507x.20170006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 12/12/2016] [Indexed: 12/17/2022] Open
Abstract
Objective The aim of the present study was to translate and cross-culturally adapt the
Functional Status Score for the intensive care unit (FSS-ICU) into Brazilian
Portuguese. Methods This study consisted of the following steps: translation (performed by two
independent translators), synthesis of the initial translation,
back-translation (by two independent translators who were unaware of the
original FSS-ICU), and testing to evaluate the target audience's
understanding. An Expert Committee supervised all steps and was responsible
for the modifications made throughout the process and the final translated
version. Results The testing phase included two experienced physiotherapists who assessed a
total of 30 critical care patients (mean FSS-ICU score = 25 ± 6). As
the physiotherapists did not report any uncertainties or problems with
interpretation affecting their performance, no additional adjustments were
made to the Brazilian Portuguese version after the testing phase. Good
interobserver reliability between the two assessors was obtained for each of
the 5 FSS-ICU tasks and for the total FSS-ICU score (intraclass correlation
coefficients ranged from 0.88 to 0.91). Conclusion The adapted version of the FSS-ICU in Brazilian Portuguese was easy to
understand and apply in an intensive care unit environment.
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Affiliation(s)
- Vinicius Zacarias Maldaner da Silva
- Programa de Ciências da Saúde, Escola Superior de Ciências da Saúde - Brasília (DF), Brasil.,Hospital de Base do Distrito Federal - Brasília (DF), Brasil
| | | | - Gerson Cipriano
- Programa de Doutorado em Ciências da Saúde e Tecnologia, Departamento de Fisioterapia, Universidade de Brasília - Brasília (DF), Brasil
| | - Mariela Pinedo
- Divisão de Pneumologia e Terapia Intensiva, Johns Hopkins University School of Medicine - Baltimore, MD, Estados Unidos.,Grupo "Outcomes After Critical Illness and Surgery" (OACIS), Johns Hopkins University - Baltimore, MD, Estados Unidos
| | - Dale M Needham
- Divisão de Pneumologia e Terapia Intensiva, Johns Hopkins University School of Medicine - Baltimore, MD, Estados Unidos.,Grupo "Outcomes After Critical Illness and Surgery" (OACIS), Johns Hopkins University - Baltimore, MD, Estados Unidos
| | - Jennifer M Zanni
- Grupo "Outcomes After Critical Illness and Surgery" (OACIS), Johns Hopkins University - Baltimore, MD, Estados Unidos
| | - Fernando Silva Guimarães
- Programa de Pós-graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta - Rio de Janeiro (RJ), Brasil.,Departamento de Fisioterapia, Universidade Federal do Rio de Janeiro - Rio de Janeiro (RJ), Brasil
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36
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Wolpat A, Lima FV, Silva FM, Tochetto M, de Freitas A, Grandi T, Rodrigues L, Paiva V, Cipriano G, Chiappa AM, Zago J, Chiappa GR. Association between inspiratory muscle weakness and slowed oxygen uptake kinetics in patients with chronic obstructive pulmonary disease. Appl Physiol Nutr Metab 2017; 42:1239-1246. [DOI: 10.1139/apnm-2016-0568] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Patients with chronic obstructive pulmonary disease (COPD) may have poor inspiratory muscle function, which reduces minute and alveolar ventilation, leading to increased hypoxemia and slow pulmonary oxygen uptake kinetics. However, little is known about the effect of inspiratory muscle weakness (IMW) on oxygen uptake kinetics in patients with COPD. Thus, we tested the hypothesis that COPD patients with IMW have slowed oxygen uptake kinetics. An observational study was conducted that included COPD patients with moderate to severe airflow limitation and a history of intolerance to exercise. Participants were divided into 2 groups: (IMW+; n = 22) (IMW–; n = 23) of muscle weakness. The maximal inspiratory, expiratory, and sustained inspiratory strength as well as the maximal endurance of the inspiratory muscles were lower in IMW+ patients (36 ± 9.5 cm H2O; 52 ± 14 cm H2O; 20 ± 6.5 cm H2O; 94 ± 84 s, respectively) than in IMW– patients (88 ± 12 cm H2O; 97 ± 28 cm H2O; 82.5 ± 54 cm H2O; 559 ± 92 s, respectively; p < 0.05). Moreover, the 6-min walk test and peak oxygen uptake were reduced in the IMW+ patients. During the constant work test, oxygen uptake kinetics were slowed in the IMW+ compared with IMW– patients (88 ± 29 vs 61 ± 18 s, p < 0.05). Our findings demonstrate that inspiratory muscle weakness in COPD is associated with slowed oxygen uptake kinetics, and thus, reduced functional capacity.
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Affiliation(s)
- Andiara Wolpat
- Physical Therapy Department, Serra Gaucha University, Caxias do Sul, Brazil
| | - Francisco V. Lima
- Physical Therapy Department, University of Brasilia, Brasilia, Brazil
| | - Fabiola M. Silva
- Physical Therapy Department, University of Brasilia, Brasilia, Brazil
| | - Micheli Tochetto
- Physical Therapy Department, Serra Gaucha University, Caxias do Sul, Brazil
| | | | - Tatiane Grandi
- Physical Therapy Department, Serra Gaucha University, Caxias do Sul, Brazil
| | - Leonardo Rodrigues
- Physical Therapy Department, Serra Gaucha University, Caxias do Sul, Brazil
| | - Verônica Paiva
- Physical Therapy Department, Serra Gaucha University, Caxias do Sul, Brazil
| | - Gerson Cipriano
- Physical Therapy Department, University of Brasilia, Brasilia, Brazil
| | - Adriana M. Chiappa
- Intensive Medicine Service, Hospital de clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Julio Zago
- Physical Therapy Department, University of Brasilia, Brasilia, Brazil
| | - Gaspar R. Chiappa
- Anhanguera Faculty of Porto Alegre, Avenida Cavalhada 4890, 91740-000
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37
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Silva PE, Maldaner V, Vieira L, de Carvalho KL, Gomes H, Melo P, Babault N, Cipriano G, Durigan JLQ. Neuromuscular electrophysiological disorders and muscle atrophy in mechanically-ventilated traumatic brain injury patients: New insights from a prospective observational study. J Crit Care 2017; 44:87-94. [PMID: 29078131 DOI: 10.1016/j.jcrc.2017.10.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 10/15/2017] [Accepted: 10/18/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE It is unclear whether the muscular changes in mechanically-ventilated traumatic brain injury patients (TBI) are only associated with disuse or additionally to neuromuscular electrophysiological disorders (NED). The correlation between muscle atrophy and NED may affect functional outcomes and rehabilitation programs significantly. MATERIAL AND METHODS An observational study was performed to investigate the presence of NED and muscle atrophy in TBI patients undergoing mechanical ventilation. NED was diagnosed by the stimulus electrodiagnosis test when chronaxie was ≥1000μs. The muscle structure (thickness and echogenicity) was assessed by B-mode ultrasound. Tibialis anterior (TA), rectus femoris (RF), and biceps brachialis (BB) muscles were analyzed. Patients were followed from the first day of admission in the intensive care unit (ICU) to the fourteenth day. RESULTS Twenty-two patients were analyzed. An increase of 48% in NED from day 1 to day 14 was detected in TA (p=0.004). All muscles presented a significant decrease in thickness (~18%, p<0.05), but echogenicity increased only in TA (19%), p<0.01 and RF (23%), p<0.01. CONCLUSIONS Mechanically-ventilated patients with TBI developed NED in addition to changes in muscle structure during their stay in the ICU.
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Affiliation(s)
- Paulo Eugênio Silva
- Physical Therapy Division, University Hospital of Brasília, University of Brasilia, Brasília, DF, Brazil; Health Sciences and Technologies PhD Program, University of Brasilia, DF, Brazil; Physical Therapy Division, Hospital de Base do Distrito Federal, Brasilia, DF, Brazil.
| | - Vinicius Maldaner
- Physical Therapy Division, Hospital de Base do Distrito Federal, Brasilia, DF, Brazil; Health Science School, Health Science Master Program, Brasilia, DF, Brazil
| | - Luciana Vieira
- Health Sciences and Technologies PhD Program, University of Brasilia, DF, Brazil; Clinical Research Center, Hospital de Base do Distrito Federal, Brasilia, DF, Brazil
| | | | - Hedian Gomes
- Physical Therapy Division, Fisioterapia Integrada de Brasília, Brasília, DF, Brazil
| | - Priscilla Melo
- Health Sciences and Technologies PhD Program, University of Brasilia, DF, Brazil; Physical Therapy Division, Hospital de Base do Distrito Federal, Brasilia, DF, Brazil
| | - Nicolas Babault
- INSERM-U1093 Cognition Action et Plasticité Senorimotrice; UFR STAPS, Université de Bourgogne-Franche-Comté, Dijon, France
| | - Gerson Cipriano
- Assistant Professor, Physical Therapy Division, University of Brasilia, Brasília, DF, Brazil
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38
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Lima ACGB, da Silva ML, da Silva VZM, Giollo LT, Silva AP, Vilela-Martin JF, Chiappa GR, Cipriano G. Vascular Peripheric Differences In Patients With Chagas Versus Ischemic Heart Failure. Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000519189.68608.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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39
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Rodrigues A, Da Silva ML, Berton DC, Cipriano G, Pitta F, O'Donnell DE, Neder JA. Maximal Inspiratory Pressure: Does the Choice of Reference Values Actually Matter? Chest 2016; 152:32-39. [PMID: 27940276 DOI: 10.1016/j.chest.2016.11.045] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 10/12/2016] [Accepted: 11/28/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Single-point measurements of maximal inspiratory pressure (MIP) are frequently used to suggest muscle weakness in clinical practice. Although there is a large variability in "mean" predicted MIP depending on the chosen reference values, it remains unclear whether those discrepancies actually impact on the prevalence of weakness, that is, MIP below the lower limit of normal. METHODS A total of 1,729 subjects (50.1% men, aged 20 to 94 years) who underwent MIP measurements in a clinical laboratory comprised the study group. MIP was predicted according to the most frequently cited regression equations as of August 2015. Pretest probability of weakness was defined by a cluster of clinical and physiologic variables. RESULTS Prevalence of weakness ranged from 33.4 to 66.9%. Set 2 equations agreed well in indicating weakness (κ [95% CI] ranging from 0.81 [0.79-0.83] to 0.83 [0.81-0.85]; P < .01). There was closer agreement between higher pretest probability of weakness and low MIP according to set 2 equations compared with set 1 equations. Thus, a significant fraction of subjects with abnormal MIP according to set 1 equations but preserved MIP according to set 2 equations had higher pretest probability of weakness (P < .05). CONCLUSIONS The choice of MIP reference values strongly impacts on the prevalence of weakness. Some specific equations relate better to clinical and physiologic indicators of weakness, suggesting that they might be particularly useful to screen subjects for advanced respiratory neuromuscular assessment.
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Affiliation(s)
- Antenor Rodrigues
- Division of Respiratory and Critical Care Medicine, Queen's University, Kingston, ON, Canada; Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, State University of Londrina, Londrina, Brazil
| | - Marianne L Da Silva
- Division of Respiratory and Critical Care Medicine, Queen's University, Kingston, ON, Canada; Department of Physiotherapy, University of Brasilia, Brasilia, Brazil
| | - Danilo C Berton
- Division of Respiratory and Critical Care Medicine, Queen's University, Kingston, ON, Canada; Division of Respirology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Gerson Cipriano
- Department of Physiotherapy, University of Brasilia, Brasilia, Brazil
| | - Fabio Pitta
- Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, State University of Londrina, Londrina, Brazil
| | - Denis E O'Donnell
- Division of Respiratory and Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - J Alberto Neder
- Pulmonary Function Laboratory, Hotel Dieu Hospital, Kingston, ON, Canada.
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40
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Nakata C, Teixeira F, Ramalho S, de Lima A, Cipriano G. ACUTE EFFECTS OF GANGLIONIC ELECTRICAL STIMULATION ON FLOW-MEDIATED VASODILATION IN HEALTHY MEN. Can J Cardiol 2016. [DOI: 10.1016/j.cjca.2016.07.352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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41
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Silva PE, Durigan JLQ, Cipriano G. Maximal Inspiratory Pressure: A Lost Point Trying to Explain a S-Index Function Line Index. J Sports Sci Med 2015; 14:883-884. [PMID: 26664287 PMCID: PMC4657433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 09/07/2015] [Indexed: 06/05/2023]
Affiliation(s)
- Paulo Eugênio Silva
- Centro Metropolitano, conjunto A, lote 01, University of Brasília, Physical Therapy Division Brasília – DF, Brazil; ZIP CODE: 72220-900.
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da Silva VZM, Durigan JLQ, Arena R, de Noronha M, Gurney B, Cipriano G. Current evidence demonstrates similar effects of kilohertz-frequency and low-frequency current on quadriceps evoked torque and discomfort in healthy individuals: a systematic review with meta-analysis. Physiother Theory Pract 2015; 31:533-9. [DOI: 10.3109/09593985.2015.1064191] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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43
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Güntzel Chiappa AM, Chiappa GR, Cipriano G, Moraes RS, Ferlin EL, Borghi-Silva A, Vieira SR. Spontaneous breathing trial in T-tube negatively impact on autonomic modulation of heart rate compared with pressure support in critically ill patients. Clin Respir J 2015; 11:489-495. [PMID: 26269215 DOI: 10.1111/crj.12363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 06/29/2015] [Accepted: 08/03/2015] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Spontaneous breathing with a conventional T-piece (TT) connected to the tracheal tube orotraqueal has been frequently used in clinical setting to weaning of mechanical ventilation (MV), when compared with pressure support ventilation (PSV). However, the acute effects of spontaneous breathing with TT versus PSV on autonomic function assessed through heart rate variability (HRV) have not been fully elucidated. OBJECTIVE The purpose of this study was to examine the acute effects of spontaneous breathing in TT vs PSV in critically ill patients. METHOD Twenty-one patients who had received MV for ≥ 48 h and who met the study inclusion criteria for weaning were assessed. Eligible patients were randomized to TT and PSV. Cardiorespiratory responses (respiratory rate -ƒ, tidal volume-VT , mean blood pressure (MBP) and diastolic blood pressure (DBP), end tidal dioxide carbone (PET CO2 ), peripheral oxygen saturation (SpO2 ) and HRV indices in frequency domain (low-LF, high frequency (HF) and LF/HF ratio were evaluated. RESULTS TT increased ƒ (20 ± 5 vs 25 ± 4 breaths/min, P<0.05), MBP (90 ± 14 vs 94 ± 18 mmHg, P<0.05), HR (90 ± 17 vs 96 ± 12 beats/min, P<0.05), PET CO2 (33 ± 8 vs 48 ± 10 mmHg, P<0.05) and reduced SpO2 (98 ± 1.6 vs 96 ± 1.6%, P<0.05). In addition, LF increased (47 ± 18 vs 38 ± 12 nu, P<0.05) and HF reduced (29 ± 13 vs 32 ± 16 nu, P<0.05), resulting in higher LF/HF ratio (1.62 ± 2 vs 1.18 ± 1, P<0.05) during TT. Conversely, VT increased with PSV (0.58 ± 0.16 vs 0.50 ± 0.15 L, P<0.05) compared with TT. CONCLUSION Acute effects of TT mode may be closely linked to cardiorespiratory mismatches and cardiac autonomic imbalance in critically ill patients.
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Affiliation(s)
| | - Gaspar R Chiappa
- Exercise Pathophysiology Research Laboratory and Cardiology Division, Hospital de Clinicas de Porto Alegre, Brazil
| | | | - Ruy S Moraes
- Department of Medicine, Faculty of Medicine, Federal University of Rio Grande Sul, Brazil
| | - Elton L Ferlin
- Biomedical Engineering, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Federal University of Sao Carlos, São Carlos, SP, Brazil
| | - Silvia R Vieira
- Intensive Medicine Service, Hospital de Clinicas de Porto Alegre, Brazil
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44
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Campos FV, Neves LM, Da Silva VZ, Cipriano GF, Chiappa GR, Cahalin L, Arena R, Cipriano G. Hemodynamic Effects Induced by Transcutaneous Electrical Nerve Stimulation in Apparently Healthy Individuals: A Systematic Review With Meta-Analysis. Arch Phys Med Rehabil 2015; 97:826-35. [PMID: 26384939 DOI: 10.1016/j.apmr.2015.08.433] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 08/13/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the immediate effects of transcutaneous electrical nerve stimulation (TENS) on heart rate, systolic blood pressure (SBP), and diastolic blood pressure (DBP) in apparently healthy adults (age ≥18y). DATA SOURCES The Cochrane Library (online version 2014), PubMed (1962-2014), EMBASE (1980-2014), and LILACS (1980-2014) electronic databases were searched. STUDY SELECTION Randomized controlled trials were included when TENS was administered noninvasively with surface electrodes during rest, and the effect of TENS was compared with that of control or placebo TENS. A sensitive search strategy for identifying randomized controlled trials was used by 2 independent reviewers. The initial search led to the identification of 432 studies, of which 5 articles met the eligibility criteria. DATA EXTRACTION Two independent reviewers extracted data from the selected studies. Quality was evaluated using the PEDro scale. Mean differences or standardized mean differences in outcomes were calculated. DATA SYNTHESIS Five eligible articles involved a total of 142 apparently healthy individuals. Four studies used high-frequency TENS and 3 used low-frequency TENS and evaluated the effect on SBP. Three studies using high-frequency TENS and 2 using low-frequency TENS evaluated the effect on DBP. Three studies using high-frequency TENS and 1 study using low-frequency TENS evaluated the effect on heart rate. A statistically significant reduction in SBP (-3.00mmHg; 95% confidence interval [CI], -5.02 to -0.98; P=.004) was found using low-frequency TENS. A statistically significant reduction in DBP (-1.04mmHg; 95% CI, -2.77 to -0.03; I(2)=61%; P=.04) and in heart rate (-2.55beats/min; 95% CI, -4.31 to -0.78; I(2)=86%; P=.005]) was found using both frequencies. The median value on the PEDro scale was 7 (range, 4-8). CONCLUSIONS TENS seems to promote a discrete reduction in SBP, DBP, and heart rate in apparently healthy individuals.
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Affiliation(s)
- Filippe V Campos
- Health Sciences and Technologies PhD Program, Department of Physical Therapy, University of Brasilia, Brasilia, Brazil; Cardiac Rehabilitation Ambulatory, Armed Forces Hospital, Brasilia, Brazil
| | - Laura M Neves
- Health Sciences and Technologies PhD Program, Department of Physical Therapy, University of Brasilia, Brasilia, Brazil; University of Para, Belém, Brazil
| | - Vinicius Z Da Silva
- Health Sciences and Technologies PhD Program, Department of Physical Therapy, University of Brasilia, Brasilia, Brazil
| | - Graziella F Cipriano
- Health Sciences and Technologies PhD Program, Department of Physical Therapy, University of Brasilia, Brasilia, Brazil
| | - Gaspar R Chiappa
- Exercise Pathophysiology Research Laboratory, Cardiology Division, Porto Alegre Hospital, Porto Alegre, Brazil
| | - Lawrence Cahalin
- Department of Physical Therapy, Leonard M. Miller School of Medicine, University of Miami, Miami, FL
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, Chicago, IL; Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL
| | - Gerson Cipriano
- Health Sciences and Technologies PhD Program, Department of Physical Therapy, University of Brasilia, Brasilia, Brazil.
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Vieira PJC, Silva LR, Maldamer VZ, Cipriano G, Chiappa AMG, Schuster R, Boni VHF, Grandi T, Wolpat A, Roseguini BT, Chiappa GR. Skeletal muscle metaboreflex in patients with chronic renal failure. Clin Physiol Funct Imaging 2015; 37:229-234. [DOI: 10.1111/cpf.12293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 06/29/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Paulo J. C. Vieira
- Exercise Pathophysiology Research Laboratory; Hospital de Clinicas de Porto Alegre; Federal University of Rio Grande do Sul; Porto Alegre Brazil
| | - Leonardo R. Silva
- Physical Therapy Division; Serra Gaucha College and Public Health Research Group; Caxias do Sul Brazil
| | | | - Gerson Cipriano
- Physical Therapy Department; University of Brasilia; Brasilia Brazil
| | | | - Rodrigo Schuster
- Physical Therapy Division; Serra Gaucha College and Public Health Research Group; Caxias do Sul Brazil
| | | | - Tatiani Grandi
- Physical Therapy Division; Serra Gaucha College and Public Health Research Group; Caxias do Sul Brazil
| | - Andiara Wolpat
- Physical Therapy Division; Serra Gaucha College and Public Health Research Group; Caxias do Sul Brazil
| | - Bruno T. Roseguini
- Exercise Pathophysiology Research Laboratory; Hospital de Clinicas de Porto Alegre; Federal University of Rio Grande do Sul; Porto Alegre Brazil
| | - Gaspar R. Chiappa
- Exercise Pathophysiology Research Laboratory; Hospital de Clinicas de Porto Alegre; Federal University of Rio Grande do Sul; Porto Alegre Brazil
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Carlos SPD, Dias AS, Forgiarini Júnior LA, Patricio PD, Graciano T, Nesi RT, Valença S, Chiappa AMG, Cipriano G, Souza CTD, Chiappa GRDS. Oxidative damage induced by cigarette smoke exposure in mice: impact on lung tissue and diaphragm muscle. J Bras Pneumol 2015; 40:411-20. [PMID: 25210964 PMCID: PMC4201172 DOI: 10.1590/s1806-37132014000400009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 07/02/2014] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To evaluate oxidative damage (lipid oxidation, protein oxidation, thiobarbituric acid-reactive substances [TBARS], and carbonylation) and inflammation (expression of phosphorylated AMP-activated protein kinase and mammalian target of rapamycin [p-AMPK and p-mTOR, respectively]) in the lung parenchyma and diaphragm muscles of male C57BL-6 mice exposed to cigarette smoke (CS) for 7, 15, 30, 45, or 60 days. METHODS Thirty-six male C57BL-6 mice were divided into six groups (n = 6/group): a control group; and five groups exposed to CS for 7, 15, 30, 45, and 60 days, respectively. RESULTS Compared with control mice, CS-exposed mice presented lower body weights at 30 days. In CS-exposed mice (compared with control mice), the greatest differences (increases) in TBARS levels were observed on day 7 in diaphragm-muscle, compared with day 45 in lung tissue; the greatest differences (increases) in carbonyl levels were observed on day 7 in both tissue types; and sulfhydryl levels were lower, in both tissue types, at all time points. In lung tissue and diaphragm muscle, p-AMPK expression exhibited behavior similar to that of TBARS. Expression of p-mTOR was higher than the control value on days 7 and 15 in lung tissue, as it was on day 45 in diaphragm muscle. CONCLUSION Our data demonstrate that CS exposure produces oxidative damage, not only in lung tissue but also (primarily) in muscle tissue, having an additional effect on respiratory muscle, as is frequently observed in smokers with COPD.
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Affiliation(s)
| | | | | | | | - Thaise Graciano
- Department of Physical Therapy, University of Southern Santa Catarina, Criciúma, Brazil
| | - Renata Tiscoski Nesi
- Institute of Biomedical Science, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Samuel Valença
- Department of Cardiology, Porto Alegre Hospital de Clínicas, Porto Alegre, Brazil
| | | | - Gerson Cipriano
- Department of Physical Therapy, University of Brasília, Brasília, Brazil
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Tomasi FP, Chiappa G, Maldaner da Silva V, Lucena da Silva M, Lima ASCGB, Arena R, Bottaro M, Cipriano G. Transcutaneous Electrical Nerve Stimulation Improves Exercise Tolerance in Healthy Subjects. Int J Sports Med 2015; 36:661-5. [PMID: 25607523 DOI: 10.1055/s-0034-1387763] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Transcutaneous electrical nerve stimulation (TENS) increases peripheral blood flow by attenuation of the muscle metaboreflex, improving oxygen supply to working muscles. We tested the hypothesis that application of TENS at ganglion improves exercise performance. 11 subjects underwent constant-work rate tests (CWR) to the limit of tolerance (Tlim) while receiving TENS or placebo. Oxygen uptake (V.O2), carbon dioxide (V.CO2), minute ventilation (V.E), ventilatory equivalent (V.E/V.CO2), heart rate (HR) and oxygen pulse (V.O2/HR) were analyzed at isotime separated by percentile and Tlim. V.O2 was lower and V.CO2 was higher at 100% of isotime during TENS, while there were no differences in V.E and V.E/V.CO2. HR was lower during exercise with TENS, and V.O2/HR increased at peak exercise (17.96±1.9 vs. 20.38±1 ml/min/bpm, P<0.05). TENS increased mechanical efficiency at isotime and Tlim (4.10±0.50 vs. 3.39±0.52%, P<0.05 and 3.95±0.67 vs. 3.77±0.45%, P<0.05) and exercise tolerance compared to P-TENS (390±41 vs. 321±41 s; P<0.05). Our data shows that the application of TENS can potentially increase exercise tolerance and oxygen supply in healthy subjects.
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Affiliation(s)
- F P Tomasi
- Physical Therapy, University of Brasilia, Brasilia, Brazil
| | - G Chiappa
- Cardiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | - A S C G B Lima
- Physical Therapy, University of Brasilia, Brasilia, Brazil
| | - R Arena
- PT, UNM, Albuquerque, United States
| | - M Bottaro
- Physical Education, University of Brasilia, Brasilia, Brazil
| | - G Cipriano
- Physical Therapy, University of Brasilia, Ceilandia, Brazil
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48
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Paolillo FR, Arena R, Dutra DB, de Cassia Marqueti Durigan R, de Araujo HS, de Souza HCD, Parizotto NA, Cipriano G, Chiappa G, Borghi-Silva A. Low-level laser therapy associated with high intensity resistance training on cardiac autonomic control of heart rate and skeletal muscle remodeling in wistar rats. Lasers Surg Med 2014; 46:796-803. [PMID: 25363390 DOI: 10.1002/lsm.22298] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Phototherapy plus dynamic exercise can enhance physical performance and improve health. The aim of our study was to evaluate the effect of low-level laser therapy (LLLT) associated with high intensity resistance training (HIT) on cardiac autonomic and muscle metabolic responses in rats. STUDY DESIGN/MATERIALS AND METHODS Forty Wistar rats were randomized into 4 groups: sedentary control (CG), HIT, LLLT and HIT + LLLT. HIT was performed 3 times/week for 8 weeks with loads attached to the tail of the animal. The load was gradually increased by 10% of body mass until reaching a maximal overload. For LLLT, irradiation parameters applied to the tibialis anterior (TA) muscle were as follows: infrared laser (780 nm), power of 15 mW for 10 seconds, leading to an irradiance of 37.5 mW/cm(2), energy of 0.15 J per point and fluency of 3.8 J/cm(2). Blood lactate (BL), matrix metalloproteinase gelatinase A (MMP(-2)) gene expression and heart rate variability (HRV) indices were performed. RESULTS BL significantly increased after 8-weeks for HIT, LLLT and HIT + LLLT groups. However, peak lactate when normalized by maximal load was significantly reduced for both HIT and HIT + LLLT groups (P<0.05). MMP-2 in the active form was significantly increased after HIT, LLLT and HIT + LLLT compared tom the CG (P<0.05). There was a significant reduction in low frequency [LF (ms(2))] and increase in high frequency [HF (un)] and HF (ms(2))] for the HIT, LLLT and HIT + LLLT groups compared with the CG (P < 0.05). However, the LF/HF ratio was further reduced in the LLLT and HIT + LLLT groups compared to the CG and HIT group (P < 0.05). CONCLUSION These results provide evidence for the positive benefits of LLLT and HIT with respect to enhanced muscle metabolic and cardiac autonomic function in Wistar rats.
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Affiliation(s)
- Fernanda Rossi Paolillo
- Optics Group from Physics Institute of São Carlos (IFSC), University of São Paulo (USP), Brazil
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Santos FV, Chiappa GR, Vieira PJC, Umpierre D, Ribeiro JP, Cipriano G. Interferential electrical stimulation improves peripheral vasodilatation in healthy individuals. Braz J Phys Ther 2014; 17:281-8. [PMID: 23966145 DOI: 10.1590/s1413-35552012005000092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 12/12/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Interferential electrical stimulation (IES), which may be linked to greater penetration of deep tissue, may restore blood flow by sympathetic nervous modulation; however, studies have found no association between the frequency and duration of the application and blood flow. We hypothesized that 30 min of IES applied to the ganglion stellate region might improve blood flow redistribution. OBJECTIVES The purpose of this study was to determine the effect of IES on metaboreflex activation in healthy individuals. METHOD Interferential electrical stimulation or a placebo stimulus (same protocol without electrical output) was applied to the stellate ganglion region in eleven healthy subjects (age 25±1.3 years) prior to exercise. Mean blood pressure (MBP), heart rate (HR), calf blood flow (CBF) and calf vascular resistance (CVR) were measured throughout exercise protocols (submaximal static handgrip exercise) and with recovery periods with or without postexercise circulatory occlusion (PECO+ and PECO -, respectively). Muscle metaboreflex control of calf vascular resistance was estimated by subtracting the area under the curve when circulation was occluded from the area under the curve from the AUC without circulatory occlusion. RESULTS At peak exercise, increases in mean blood pressure were attenuated by IES (p<0.05), and the effect persisted under both the PECO+ and PECO- treatments. IES promoted higher CBF and lower CVR during exercise and recovery. Likewise, IES induced a reduction in the estimated muscle metaboreflex control (placebo, 21±5 units vs. IES, 6±3, p<0.01). CONCLUSION Acute application of IES prior to exercise attenuates the increase in blood pressure and vasoconstriction during exercise and metaboreflex activation in healthy subjects.
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Cipriano G, Neder JA, Umpierre D, Arena R, Vieira PJC, Chiappa AMG, Ribeiro JP, Chiappa GR. Sympathetic ganglion transcutaneous electrical nerve stimulation after coronary artery bypass graft surgery improves femoral blood flow and exercise tolerance. J Appl Physiol (1985) 2014; 117:633-8. [PMID: 25103974 DOI: 10.1152/japplphysiol.00993.2013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We tested the hypothesis that transcutaneous electrical nerve stimulation (TENS) over the stellate ganglion region would reduce sympathetic overstimulation and improve femoral blood flow (FBF) after coronary artery bypass graft surgery. Thirty-eight patients (20 men, 24 New York Heart Association class III-IV) were randomized to 5-day postoperative TENS (n = 20; 4 times/day; 30 min/session) or sham TENS (n = 18) applied to the posterior cervical region (C7-T4). Sympathetic nervous system was stimulated by the cold pressor test, with FBF being measured by ultrasound Doppler. Femoral vascular conductance (FVC) was calculated as FBF/mean arterial pressure (MAP). Six-min walking distance established patients' functional capacity. Before and after the intervention periods, pain scores, opiate requirements, and circulating β-endorphin levels were determined. As expected, preoperative MAP increased and FBF and FVC decreased during the cold pressor test. Sham TENS had no significant effect on these variables (P > 0.05). In contrast, MAP decreased in the TENS group (125 ± 12 vs. 112 ± 10 mmHg). This finding, in association with a consistent increase in FBF (95 ± 5 vs. 145 ± 14 ml/min), led to significant improvements in FVC (P < 0.01). Moreover, 6-min walking distance improved only with TENS (postsurgery-presurgery = 35 ± 12 vs. 6 ± 10 m; P < 0.01). TENS was associated with lesser postoperative pain and opiate requirements but greater circulating β-endorphin levels (P < 0.05). In conclusion, stellate ganglion TENS after coronary artery bypass graft surgery positively impacted on limb blood flow during a sympathetic stimulation maneuver, a beneficial effect associated with improved clinical and functional outcomes.
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Affiliation(s)
- Gerson Cipriano
- Physical Therapy Department, University of Brasilia, Brasilia, Brazil
| | - J Alberto Neder
- Laboratory of Clinical Exercise Physiology, Division of Respiratory and Critical Care Medicine, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Daniel Umpierre
- Exercise Pathophysiology Research Laboratory and Cardiology Division, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois Chicago, Chicago, Illinois
| | - Paulo J C Vieira
- Exercise Pathophysiology Research Laboratory and Cardiology Division, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Jorge P Ribeiro
- Exercise Pathophysiology Research Laboratory and Cardiology Division, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Gaspar R Chiappa
- Exercise Pathophysiology Research Laboratory and Cardiology Division, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil; Public Health Research Group, Division of Physical Therapy, Serra Gaucha College, Caxias do Sul, Brazil
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