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Introduction  Dysphagia induced by radiotherapy in the head and neck region comprises a challenging scenario and sometimes difficult rehabilitation due to the severity of the adverse effects. Some resources such as electrical stimulation have emerged as an alternative to complement the therapeutic process, but there is still no consensus on its use. Objective  The purpose of the present study was to evaluate, through a meta-analysis, the effect of electrical stimulation on the rehabilitation of dysphagia generated after head and neck cancer treatment. Data Synthesis  Four randomized controlled trials with a total of 146 participants were included. The age of the participants was 58.37 ± 1.8 years old and there was a predominance of males. The time to start the intervention ranged from 50.96 ± 40.12 months after cancer treatment. The intervention showed great heterogeneity regarding the positioning of the electrodes, parameters, duration of the stimulus, number of sessions, and intensity. No difference was identified in the following aspects: oral transit time, hyoid elevation, penetration and/or aspiration after electrostimulation. The quality of the evidence ranged from very low to moderate and high risk of bias. Conclusion In this meta-analysis, we found weak evidence for small and moderate swallowing benefits in patients after radiotherapy for head and neck cancer in short-term clinical trials., Competing Interests: Conflict of Interests The authors have no conflict of interests to declare., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit ( https://creativecommons.org/licenses/by/4.0/ ).)

Purpose: To identify the effects of prophylactic, non-pharmacological measures on the progression of dysphagia in patients with head and neck cancer undergoing radiotherapy., Research Strategies: The search was performed in Medline (via PubMed), Scopus, and Embase databases, as well as in the gray literature., Selection Criteria: Randomized clinical trials were included, with adult patients (≥ 18 years old) and diagnosed with head and neck cancer, treated with radiotherapy (with or without surgery and chemotherapy), and submitted to non-pharmacological protocols for the prevention of dysphagia., Data Analysis: The risk of bias was assessed using the PEDRO scale and the overall quality of evidence was assessed using the GRADE instrument., Results: Four studies were considered eligible, and of these, two were included in the meta-analysis. The result favored the intervention group, with a mean difference of 1.27 [95% CI: 0.74 to 1.80]. There was low heterogeneity and the mean score for risk of bias was 7.5 out of 11 points. The lack of detail in the care with selection, performance, detection, attrition, and reporting biases contributed to the judgment of the quality of the evidence, considered low., Conclusion: Prophylactic measures to contain dysphagia can promote important benefits on the oral intake of patients with head and neck cancer when compared to those who did not undergo such a therapeutic measure during radiotherapy.

Objective: To assess the effect of physical therapy on cancer-related fatigue (CRF) during cytotoxic anticancer treatment., Methods: Systematic review with meta-analysis of randomized clinical trials published from 2010 to 2021 (EMBASE, MEDLINE, PEDro; SciELO, and LILACS). Studies assessing the effect of supervised physical therapy (IG) for the management of CRF on adults undergoing anticancer treatment compared with a control group (CG) covering usual care or any uncontrolled practice, such as recommendations about exercise and health education, were included in this review., Results: A total of 22 studies were included in the SR and 21 in the meta-analysis, resulting in 1.992 individuals (CG = 973 and IG = 1.019). There was a reduction in general fatigue [SMD =  - 0.69; 95%CI (- 1.15, - 0.22) p < 0.01; I 2  = 87%; NNT = 3], with greater weight attributed to combined exercise (44%). Physical fatigue also reduced [SMD =  - 0.76; 95%CI (- 1.13, - 0.39) p < 0.01; I 2  = 90%; NNT = 2], with greater weight for resistance exercise (50%) and greater effect with combined exercise [SMD =  - 1.90; 95%CI (- 3.04, - 0.76) p < 0.01; I 2  = 96%]. There was reduction in general fatigue with moderate intensity (74%) [SMD =  - 0.89; 95%CI (- 1.61, - 0.17) p < 0.02; I 2  = 90%] and physical fatigue [SMD =  - 1.00; 95%CI (- 1.54, - 0.46) p < 0.01; I 2  = 92%], while high intensity reduced only general fatigue [SMD =  - 0.35; 95%CI (- 0.51, - 0.20) p < 0.01; I 2  = 0%]. The number of overall and weekly sessions has been shown to contribute to the reduction of CRF., Conclusion: Physical rehabilitation with moderate intensity promoted greater relief of general and physical fatigue. Even after controlling for high heterogeneity, the quality of evidence, summarized in GRADE, was considered moderate for general fatigue and low for physical fatigue., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: The aim of this study is to systematically review the effect of inspiratory muscle training (IMT) associated or not with physical rehabilitation in the preoperative period of anatomical pulmonary resection., Methods: Search in the databases: MEDLINE, Cochrane CENTRAL, EMBASE, LILACS and PEDro up to November 2019. Randomized clinical trials (RCTs) were included in adults in the preoperative period of pulmonary resection. The selection of studies and data extraction was performed by two independent reviewers. The risk of bias assessed with RoB 2.0 and the quality of evidence with GRADE., Prospero: CRD42018105859., Results: Six RCTs were included; patients who underwent IMT in the preoperative period showed a significant improvement in functional capacity assessed by the 6-min walk test (6WT) (MD 28,93 [IC 95% 0,28; 57,58], p = 0,04, I 2  = 0%) and significantly reduced the length of hospital stay (MD -3,63 [IC 95% -4,96; -2,29], p = 0,00, I 2  = 0%). There was no significant difference between groups regarding pulmonary function, in postoperative complications such as pneumonia (RR 0,56 [IC 95% 0,29; 1,10], p = 0,09, I 2  = 0%), atelectasis (RR 0,81 [IC 95% 0,24; 2,69], p = 0,72, I 2  = 0%), mechanical ventilation > 48 h (RR 0,43 [IC 95% 0,12; 1,58], p = 0,20, I 2  = 0%), in mortality (RR 0,33 [IC 95% 0,04; 3,12], p = 0,33, I 2  = 0%), and quality of life., Conclusion: IMT associated with physical exercise in the preoperative period of pulmonary resection improves functional capacity and reduces the length of hospital stay in the postoperative period., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: To analyze the influence of acute aerobic exercise (AE) plus thoracic mobilization in pain perception and autonomic nervous system response in healthy adults., Design: Randomized clinical trial., Methods: Forty-eight asymptomatic adults were allocated into one of three groups: 1) Aerobic Exercise (AE), 2) Aerobic Exercise + Mobilization (AE + M), and 3) Placebo. Participants from groups AE and AE + M ran for 5 min on a treadmill with a 75-85% of age-predicted heart rate. Participants from AE + M group also received a rotatory thoracic passive accessory intervertebral mobilization at T4 after running. Participants from the Placebo group received placebo mobilization. We mesured the autonomic system modulation through Heart Rate Variability (HRV) (time-domain, frequency-domain, and non-linear variables). We measured Pressure Pain Threshold (PPT) with a handheld digital algometer., Results: While aerobic exercise increased the sympathetic outflow and reduced the HRV, the addition of vertebral mobilization to exercise had no further effect on autonomic system modulation. There was no change in PPT in any group. Besides, there was no correlation between HRV and PPT., Conclusion: Thoracic mobilization did not increase the sympathetic response induced by aerobic exercise. Moreover, exercise alone or exercise plus thoracic mobilization did not change the PPT., Competing Interests: Declaration of competing interest None declared., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Previous studies have shown beneficial effects of physical exercise (PE) in adults submitted to hematopoietic stem cell transplantation (HSCT). Conduct a systematic review about the effects of PE on the functional capacity of children and adolescents submitted to HSCT. The studies were searched in the databases MEDLINE (via PubMed), Central Register of Controlled Trials (Cochrane CENTRAL), EMBASE, LILACS, and Evidence Database in Physical Therapy (PEDro) (CRD42018080093). Two independent reviewers performed the article selection, data extraction, and methodological quality assessment. Randomized and nonrandomized clinical trials comparing PE with usual treatment in children and adolescents aged 3-18 years were included. The risk of bias was assessed using the Cochrane Collaboration tool and ROBINS-I tool, and the overall quality of the evidence was determined by the GRADE system. We included three studies with 91 patients. PE improved the functional capacity assessed by the timed up and down stairs test (MD -1.23 [95% CI, 2.27 to -.20, I2 = 0%]), but there was no significant effect in the six-minute walk test (MD 44.63 [95% CI, -20.86 to 110.13, I2 = 83%]). The benefits regarding quality of life and peripheral muscle strength of these individuals were not clearly demonstrated, but positive responses were observed in relation to the analyzed data. None of the studies evaluated the fatigue. The limitations found were the high heterogeneity between studies, as well as the sample size and the low methodological rigor. PE might be favorable to improve the functional capacity of children and adolescents treated with HSCT. However, further studies are needed to clarify the best PE program.

Background: Lifestyle intervention programs comprise the first-choice therapy to reduce the cardiovascular risk factors in metabolic syndrome (MetS). Our aim was to compare the effects of three lifestyle modification programs on the number of diagnostic criteria and clinical parameters of MetS. Methods: Twelve-week clinical trial, including 125 adults who presented at least three of the criteria defined by the revised NCEP ATP III (National Cholesterol Education Program Adult Panel III) for MetS. Individuals were randomized into three multidisciplinary intervention groups: Standard Intervention (SI), Group Intervention (GI) and Individual Intervention (II). Results: Seventy-one individuals, aged 34-59 years, concluded the study: SI: 20, GI: 25, and II: 26. The GI and II groups presented a significant decrease of body mass index, abdominal circumference, diastolic and systolic arterial pressure after intervention. The number of diagnostic criteria for MetS decreased significantly. Within the GI and II groups, 16.0% and 15.4% of the individuals, respectively, did not meet the criteria for the clinical condition studied at the end of the interventions. In the II group, the percentage of individuals with five criteria reduced 83.5%. In the GI group, the percentage of individuals with five criteria remained the same, but the number of individuals with four criteria presented a 50.0% reduction. Conclusions: Results reinforce that nonpharmacological strategies for changing lifestyle affect the reduction of cardiovascular risk factors existing in MetS. They are also able to remove the population from this clinical condition by decreasing the diagnostic criteria. II or GI lead to a successful treatment of MetS, especially when conducted by multidisciplinary team. Brazilian Registry of Clinical Trials-ReBEC number: RBR-9wz5fc.

Background: Chronic kidney disease is a complex disease that impacts multiple organs and systems (including musculoskeletal and cardiorespiratory) leading to reduction of functional capacity., Objective: The aim of this study was to investigate the effect of a short period of high intensity inspiratory muscle training on maximum inspiratory pressure, functional capacity and endothelial function of chronic kidney disease patients on hemodialysis., Methods: This randomized controlled trial enrolled 25 patients who were allocated into two groups: intervention (IMTG=14) and control (CG=11) groups. Intervention patients received the exercise protocol over a period of 5 weeks, 6 times per week, with each session consisting of 5 sets of 10 repetitions with an initial load of 50% progressing to 70% of maximum inspiratory pressure , measured weekly. The primary outcome was inspiratory muscle strength and the secondary outcomes were functional capacity and endothelial function evaluated before and after the training protocol., Results: The inspiratory muscle training induced a marked improvement in maximum inspiratory pressure which was evident after the training period (mean difference 19.0cmH 2 O - 95%CI 0.4-37.5; IMTG: 102±25.7cmH 2 O vs CG: 83±19.2; p=0.046). The magnitude of maximum inspiratory pressure improvement was 33.5% at the end of the protocol for the IMTG. Functional capacity and endothelial function did not vary between or within groups., Conclusion: A short period of high-intensity inspiratory muscle training for five weeks was able to improve inspiratory muscle strength of chronic kidney disease patients on hemodialysis (ClinicalTrials.gov registration NCT03082404)., (Copyright © 2019 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Purpose: To analyze the effects of electrical stimulation on the salivary flow of head and neck cancer patients with radiotherapy-induced hyposalivation., Research Strategies: Searches were made in the Medline (via Pubmed), Cochrane Library, Scopus and Lilacs databases., Selection Criteria: Selection included clinical trials that evaluated salivary flow objectively, published in the last 10 years in either Portuguese, English or Spanish., Data Analysis: The PEDro scale was used for the methodological evaluation of the studies., Results: The search strategy resulted in 21 publications, 17 of which were excluded, hence there were 4 articles left. The included studies had a total of 212 participants, all of whom had an increase in salivary flow, both through the electroacupuncture method and direct application on the salivary glands. The score obtained through the PEDRo scale was low, evidencing questionable methodological quality and risk of bias., Conclusion: The included studies demonstrate the clinical potential of TENS to increase the salivary flow of head and neck cancer patients treated with RT.

Introduction: The aim of this study was to evaluate the dimensions of the vaginal canal in patients undergoing gynaecological brachytherapy and the effect of the use of vaginal dilators (VD) used in the follow-up of pelvic physiotherapy., Methods: A total of 88 patients were randomly allocated to the control group (CG) and intervention group (IG). Three evaluations were performed: pre-brachytherapy, post-brachytherapy and follow-up of 3 months. The CG received standard guidance from the health team while the IG was instructed to use VD for 3 months. The dimensions of the vaginal canal (main outcome) were defined by the length of the vagina (centimetres), width (number of full clockwise turns of the opening thread of a gynaecological speculum) and area (defined by the size of the VD). Quality of life and pelvic floor (PF) functionality were also evaluated., Results: There was no effect of the VD on vaginal length, width and area among the intention-to-treat (ITT) population. However, in the analysis stratified by adhesion, the CG had a significant decrease in the vaginal area. PF was predominantly hypoactive throughout the follow-up. Quality of life improved in both groups, but the reduction of constipation, vaginal dryness and stress urinary incontinence manifested only in the IG., Conclusion: The use of VD did not alter the dimensions of the vaginal canal within the first 3 months after the end of radiotherapy treatment. However, there was a large sample loss during follow-up so studies with a larger sample number and longer follow-up time need to be conducted., Trial Registration: ClinicalTrials.gov Identifier NCT03090217.

Pre-exercise photobiomodulation therapy (PBMT) reduces fatigue and enhances performance in different populations. However, PBMT benefits have never been tested on chronic kidney disease (CKD) patients, who present muscle weakness, fatigue, and reduced functional performance. The objective of this study was to evaluate the acute effect of three different doses of the PBMT on maximal handgrip strength of CKD patients. Fifteen volunteers (58 ± 8 years, 10 male/5 female) under chronic hemodialysis treatment (6 ± 4 years) participated in a randomized, crossover, double-blind, placebo-controlled trial. Each patient was assessed at four hemodialysis sessions with 1 week interval between evaluations. Placebo or PBMT (cluster probe with five 850 nm/200 mW laser diodes) were applied at three sites along the flexors of the finger (total doses of 60, 90, or 120 J per arm). The maximal handgrip strength was evaluated before and after PBMT/placebo treatment in each session. Repeated measures ANOVA and intraclass correlation coefficients (ICC) confirmed no learning effect on handgrip tests, and high scores for test-retest reliability (ICC scores = 0.89 to 0.95). Significant strength increases occurred after PBMT application with doses of 60 J/arm (4.85%, p = 0.005, ES = 0.32) and 90 J/arm (4.45%, p = 0.013, ES = 0.25), while no changes were detected with placebo or 120 J/arm. In conclusion, in consensus with a recent systematic review, a single bout of the 60 J/arm was the best dose/response for increased strength of the small muscles (handgrip strength). In view of the increasing implementation of exercise programs during hemodialysis, the current study opens a new field for PBMT for CKD patients.

Scientific and technological advances, coupled with the work of multidisciplinary teams in intensive care units, have increased the survival of critically ill patients. An essential life support resource used in intensive care is extracorporeal membrane oxygenation. Despite the increased number of studies involving critically ill patients, few studies to date have demonstrated the safety and benefits of physical therapy combined with extracorporeal membrane oxygenation support. This review identified the clinical outcomes of physical therapy in adult patients on extracorporeal membrane oxygenation support by searching the MEDLINE®, PEDro, Cochrane CENTRAL, LILACS, and EMBASE databases and by manually searching the references of the articles published until September 2017. The database search retrieved 1,213 studies. Of these studies, 20 were included in this review, with data on 317 subjects (58 in the control group). Twelve studies reported that there were no complications during physical therapy. Cannula fracture during ambulation (one case), thrombus in the return cannula (one case), and leg swelling (one case) were reported in two studies, and desaturation and mild vertigo were reported in two studies. In contrast, improvements in respiratory/pulmonary function, functional capacity, muscle strength (with reduced muscle mass loss), incidence of myopathy, length of hospitalization, and mortality in patients who underwent physical therapy were reported. The analysis of the available data indicates that physical therapy, including early progressive mobilization, standing, ambulation, and breathing techniques, together with extracorporeal membrane oxygenation, is feasible, relatively safe, and potentially beneficial for critically ill adult patients.

Background: There is little evidence of how metabolic syndrome (MS) affects sympathovagal balance responses to acute physical effort (APE) and autonomic stimulation (AS). This study aimed to evaluate the heart rate variability (HRV) responses to the combined APE and AS challenges., Methods: Fourteen subjects (8 men; 49.15 ± 8.67 years) divided into two groups: 7 healthy volunteers [control group (CG)] and 7 patients with MS. Sympathovagal balance [low frequency (LF)/high frequency (HF) ratio] was accessed by HRV through the beat-to-beat heart rate (HR) electrocardiogram. Other variables analyzed were as follows: HR, RR-interval variance (VAR/ms 2 ), LF and HF normalized units (un). The APE consisted of a 30-min walk at 65%-75% of the age-predicted maximal HR. The AS was achieved by changing from the supine to standing position (activity orthostatic position)., Results: At rest, all HRV variables differ with on MS, but after APE and AS LF (nu) and HF (nu) become similar to the CG. However, the LF/HF ratio responses to the AS were significantly different after APE, but only in the MS (CG rest: 367% ± 59% vs. recovery 495% ± 116%, P > 0.05; MS rest: 316% ± 88% vs. recovery: 665% ± 165%; P = 0.045). Comparing the difference between AS in rest and recovery (ΔAS = rest - recovery), the LF/HF ratio was notably higher in the MS group (CG: 94% ± 29% vs. MS: 415% ± 76%; P < 0.0001)., Conclusions: The APE and AS induced by body posture changes activated a clear distinction in sympathovagal balance response in MS.

Background: Chronic kidney failure (CKF) patients on renal replacement therapies exhibit elevated levels of DNA lesions and this is directly related to high mortality., Objective: This study aimed to evaluate the effect of neuromuscular electrical stimulation (NMES) on genomic damage in CKF patients on conventional haemodialysis (HD)., Methods: Twenty-one patients with CKF on HD were randomized into control (CG =10) or neuromuscular electrical stimulation (NMESG = 11) groups. NMES was applied on the quadriceps muscle during the HD session, three times a week, for 8 weeks in NMESG. DNA damage in blood was evaluated by the alkaline comet assay prior to follow-up, after 4 and 8 weeks of intervention., Results: Intradialytic NMES in CKF patients induced a significant decrease in DNA damage after four [49.9 (3.68) vs 101.5 (6.53); p = 0.000] than eight [19.9 (2.07) vs 101.5 (6.53); p = 0.000] weeks compared to baseline. Genomic damage was also significantly less after four [NMESG: 49.9 (3.68) vs CG: 92.9 (12.61); p = 0.001] than after eight [NMESG: 19.9 (2.07) vs CG: 76.4 (11.15); p = 0.000] weeks compared to CG., Conclusions: This study demonstrates for the first time that intradialytic NMES is able to reduce DNA damage in blood of CKF patients.

Background: Actually the lifestyle exposes the population to several risk factors related to alimentary habits and less physical activity that contributes to chronic diseases appearance worldwide., Aim: To analyze the association between salivary cortisol and the components of metabolic syndrome., Methods: This is a cross-sectional study. As part of it, 28 individuals aged 30-59 years presenting three or more of the following findings: CA: ≥88 cm for women and ≥102 cm for men; SBP>130 mmHg and DBP>85 mmHg; GL>100 mg/dl; TG>150 mg/dl; HDL<40 mg/dl for men and <50 mg/dl for women. Was performed analysis of salivary cortisol (by radioimmunoassay) from 25 salivary samples collected throughout the day, for evaluating changes in the circadian rhythm of this hormone (8AM, noon and 8PM)., Results: 28 evaluated individuals had a mean age of 51.9±7.5 years, mostly women (64.3%) and a mean of BMI 33.6±3.2 kg/m². The cortisol level from the 8AM averaged 18.7±4.8 ng/dlL. Individuals with FPG>110mg/dl, have significantly lower average levels of cortisol than ones with FPG <110 (12.8±5,2 vs. 17.3±4.2). Significant correlations were HOMA vs. WC (r=0,465; p˂0,005) and TG (r=0,473; p˂0,005), WC vs. FG (r=0,446; p˂0,005) and BMI (r=0,730; p˂0.0001); TG vs. HDL (r=0,441 p˂0,005) and FG (r=0,440; p˂0,005)., Conclusion: Morning salivary cortisol in subjects with chronically elevated blood glucose can represent a downregulation of the hypothalamic-pituitary adrenal axis. This is an important finding not yet well investigated.

Purpose: To verify the acute effect of electrostimulation on the salivary flow of patients with hyposalivation., Methods: Uncontrolled clinical trial evaluating 15 patients with hyposalivation induced by radiotherapy (RT) used for head and neck cancer treatment. Mean age of the patients was 56.8 ± 6.46 years. Males outnumbered females (73%). Transcutaneous Electrical Nerve Stimulation (TENS) was adjusted with 50Hz of frequency and 250μs of pulse width. Intensity was adjusted over a 20-minute period according to maximum tolerance. The electrodes were attached bilaterally on the region of the salivary glands. Evaluation of the salivary flow was performed through sialometry before and immediately after application of TENS., Results: The most prevalent region for RT was the oropharynx (80.0% of cases). The mean dose used in RT was 64.6 ± 7.27 Gy. After TENS, salivary flow increased significantly (p = 0.0051) from 0.05 (0.00; 0.40) mL/min to 0.10 (0.07: 0.40) mL/min. The response to TENS was directly correlated with the intensity of the tolerated electric current (r = 0.553; p = 0.032) and the dose used in RT (r = -0.514; p = 0.050)., Conclusion: TENS was able to increase the salivary flow rate of patients with RT-induced hyposalivation.

Objective: To compare the effects of two different mobilization techniques and a placebo intervention applied to the thoracic spine on heart rate variability (HRV) and pressure pain threshold (PPT) in asymptomatic individuals., Methods: Sixty healthy asymptomatic subjects aged between 18 and 40 years old were randomized to a single session of one of the three interventions: posterior-to-anterior (PA) rotatory thoracic passive accessory intervertebral mobilization (PAIVM) (PA group), unilateral thoracic PA in slump position (SLUMP group) or placebo intervention (Placebo group). HRV and PPT at C7 and T4 spinous process, first dorsal interossei muscles bilaterally, and muscle belly of tibialis anterior bilaterally were measured before and immediately after the intervention. A univariate analysis of covariance (ANCOVA) adjusted for baseline values assessed the effect of "Group". Pairwise comparisons with Bonferroni adjustment for multiple comparisons were performed., Results: There were no significant between-group differences for HRV. A significant between-group difference for PPT in the ipsilateral tibia was found favoring the SLUMP group in comparison with the PA group. There were no significant between-group differences for PPT in the other landmarks., Conclusion: A single treatment of thoracic PAIVM in prone lying and slump position did not alter PPT and HRV compared to placebo in asymptomatic subjects., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Patients with hypertension have altered autonomic nervous system function, which are increased sympathetic activity. Transcutaneous Electrical Nerve Stimulation (TENS) is a useful modality for pain control and has also been shown to be effective in the reduction of sympathetic activity in healthy subjects and individuals with cardiovascular diseases., Objective: The aim of this study was to verify the effects of transcutaneous electrical nerve stimulation by the evaluation of heart rate variability (HRV) in patients with essential hypertension., Method: Twenty-eight patients received an application of low-frequency TENS(4 Hz) n=8, highfrequency TENS (100 Hz) n=10 or placebo TENS n=10 in paravertebral ganglionar region during thirty minutes., Results: After 4 Hz TENS, there was a decrease in the low-frequency (LFn.u.) component (57.71±9.46 vs 45.58±13.51, p<0.026) and an increase in the high-frequency (HFn.u.) component (33.03±13.83 vs 45.83±20.19, p <0.05) of HRV. After 100 Hz TENS and placebo, there were no changes in the LF and HF components. No significant differences were found in systolic blood pressure with low-frequency TENS (129.37± 15.48 vs 126.69 ± 15.21, p<0.490). There was an increase, although not significant, with high-frequency TENS (131.00 ± 15.97 vs 138.75 ± 25.79, p<0.121) and placebo (133.80 ± 29.85 vs 134.80 ± 29.72, p< 0.800). No differences were found in the diastolic blood pressure with low-frequency TENS and placebo, but there was a significant increase in high-frequency TENS (81.00 ± 11.78 vs 85.65 ± 13.68, p< 0.018)., Conclusion: Low-frequency TENS decreases sympathetic nervous system activity and increases parasympathetic nervous system activity and high-frequency TENS increases diastolic blood pressure, when applied on the paravertebral ganglionar region in the hypertensive patients., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.)

Objective:: To review the literature on the effects of expiratory rib cage compression on ventilatory mechanics, airway clearance, and oxygen and hemodynamic indices in mechanically ventilated adults., Methods:: Systematic review with meta-analysis of randomized clinical trials in the databases MEDLINE (via PubMed), EMBASE, Cochrane CENTRAL, PEDro, and LILACS. Studies on adult patients hospitalized in intensive care units and under mechanical ventilation that analyzed the effects of expiratory rib cage compression with respect to a control group (without expiratory rib cage compression) and evaluated the outcomes static and dynamic compliance, sputum volume, systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, peripheral oxygen saturation, and ratio of arterial oxygen partial pressure to fraction of inspired oxygen were included. Experimental studies with animals and those with incomplete data were excluded., Results:: The search strategy produced 5,816 studies, of which only three randomized crossover trials were included, totaling 93 patients. With respect to the outcome of heart rate, values were reduced in the expiratory rib cage compression group compared with the control group [-2.81 bpm (95% confidence interval [95%CI]: -4.73 to 0.89; I2: 0%)]. Regarding dynamic compliance, there was no significant difference between groups [-0.58mL/cmH2O (95%CI: -2.98 to 1.82; I2: 1%)]. Regarding the variables systolic blood pressure and diastolic blood pressure, significant differences were found after descriptive evaluation. However, there was no difference between groups regarding the variables secretion volume, static compliance, ratio of arterial oxygen partial pressure to fraction of inspired oxygen, and peripheral oxygen saturation., Conclusion:: There is a lack of evidence to support the use of expiratory rib cage compression in routine care, given that the literature on this topic offers low methodological quality and is inconclusive.

Background: Lifestyle intervention programs can reduce the prevalence of metabolic syndrome (MetS) and, therefore, reduce the risk for cardiac disease, one of the main public health problems nowadays., Objective: The aim of this study was to compare the effects of three types of approach for lifestyle change programs in the reduction of metabolic parameters, and to identify its impact on the quality of life (QOL) of individuals with MetS., Methods: A randomized controlled trial included 72 individuals with MetS aged 30-59 years. Individuals were randomized into three groups of multidisciplinary intervention [Standard Intervention (SI) - control group; Group Intervention (GI); and Individual Intervention (II)] during 12 weeks. The primary outcome was change in the metabolic parameters, and secondarily, the improvement in QOL measures at three moments: baseline, 3 and 9 months., Results: Group and individual interventions resulted in a significant reduction in body mass index, waist circumference, systolic blood pressure at 3 months and the improvement of QOL, although it was significantly associated with the physical functioning domain. However, these changes did not remain 6 months after the end of intervention. Depression and anxiety were significantly associated with worse QOL, although they showed no effect on the response to intervention., Conclusion: Multidisciplinary intervention, especially in a group, might be an effective and economically feasible strategy in the control of metabolic parameters of MetS and improvement of QOL compared to SI, even in a dose-effect relationship., Competing Interests: Potential Conflict of Interest No potential conflict of interest relevant to this article was reported.

The study objectives were (1) comparison of baseline characteristics between individuals with metabolic syndrome, adhering/not adhering to a primary prevention program modificação do estilo de vida e risco cardiovascular; and (2) determination of risk factors for program adherence. The sample included 127 participants with mean age (±standard deviation) of 49.58 (±7.77) years, participating in the modificação do estilo de vida e risco cardiovascular between 2010 and 2012. Results show that program adherence predictors were age (odds ratio: 1.134, 95% confidence interval: 1.106-1.833); practicing physical exercise (odds ratio: 1.322, 95% confidence interval: 1.115-7.589); self-efficacy for regular eating habits (odds ratio: 2.044, 95% confidence interval: 1.184-3.377); low binge eating scores (odds ratio: 1.922, 95% confidence interval: 1.118-3.974); and low isolation and depression scores (odds ratio: 0.721, 95% confidence interval: 0.322-0.917)., (© The Author(s) 2015.)

Objective: To compare the efficacy of a cycle ergometer-based exercise program to a standard protocol on the increment of the maximum distance walked during the six-minute walk test in the postoperative rehabilitation of patients submitted to coronary artery bypass grafting., Methods: A controlled clinical trial pilot, blinded to the outcome, enrolled subjects who underwent coronary artery bypass grafting in a hospital from Southern Brazil. Subjects were designated for the standard physical rehabilitation protocol or to an alternative cycle ergometer-based protocol through simple random sampling. The primary outcome was the difference in the maximum distance walked in the six-minute walk test before and after the allocated intervention., Results: Twenty-four patients were included in the analysis, 10 in the standard protocol and 14 in the alternative protocol group. There was an increment in the maximum distance walked in both groups, and borderline superiority in the intervention group comparing to the control group (312.2 vs. 249.7; P=0.06)., Conclusion: There was an increase in the maximum distance walked in the alternative protocol compared to the standard protocol. Thus, it is postulated that the use of a cycle ergometer can be included in physical rehabilitation in the hospital phase of postoperative coronary artery bypass grafting. However, randomized studies with larger sample size should be conducted to assess the significance of these findings.

Metabolic Syndrome is a complex clinical condition that brings together a set of cardiovascular risk factors. Lifestyle changes, such as eating habit improvements, are first-choice therapies for the treatment of this clinical condition. This study aimed to evaluate the effect of short-term nutritional counseling, on the diet quality and total energetic value (TEV) in individuals with Metabolic Syndrome. Eighty subjects (men and women) aged 30 to 60 years with metabolic syndrome were followed over three months. The Healthy Eating Index tool adapted to the Brazilian population was used for the evaluation of diet quality. Mean age was 51 + 6 years, and 68.6% were women. The mean score of the dietary quality of the population studied increased significantly from 53.02 to 61.65 after intervention. The amount of individuals classified as Inappropriate Diet decreased significantly six-fold, the amount of individuals classified as Healthy Diet increased four-fold, and the percent of diets classified as Diet that Needs Change decreased by 25% when compared to the beginning of the study. Adequate intake of vegetables was inversely associated to abdominal circumference, as well as adequate intake of sodium and fasting serum insulin. The amount of TEV presented a significant reduction (p <0.000) after intervention. The short-term nutritional counseling showed to be efficient to improve dietary quality. Associations between dietary quality and variables studied highlight the importance of nutritional intervention in individuals with metabolic syndrome.

Background: Metabolic syndrome is a complex disorder represented by a set of cardiovascular risk factors. A healthy lifestyle is strongly related to improve Quality of Life and interfere positively in the control of risk factors presented in this condition., Objective: To evaluate the effect of a program of lifestyle modification on the Framingham General Cardiovascular Risk Profile in subjects diagnosed with metabolic syndrome., Methods: A sub-analysis study of a randomized clinical trial controlled blind that lasted three months. Participants were randomized into four groups: dietary intervention + placebo (DIP), dietary intervention + supplementation of omega 3 (fish oil 3 g/day) (DIS3), dietary intervention + placebo + physical activity (DIPE) and dietary intervention + physical activity + supplementation of omega 3 (DIS3PE). The general cardiovascular risk profile of each individual was calculated before and after the intervention., Results: The study included 70 subjects. Evaluating the score between the pre and post intervention yielded a significant value (p < 0.001). We obtained a reduction for intermediate risk in 25.7% of subjects. After intervention, there was a significant reduction (p < 0.01) on cardiovascular age, this being more significant in groups DIP (5.2%) and DIPE (5.3%)., Conclusion: Proposed interventions produced beneficial effects for reducing cardiovascular risk score. This study emphasizes the importance of lifestyle modification in the prevention and treatment of cardiovascular diseases.

Objective: The main goal of the present study was to investigate the xanthine oxidase (XO) activity in metabolic syndrome in subjects submitted to a single exercise session. We also investigated parameters of oxidative and inflammatory status., Materials/methods: A case-control study (9 healthy and 8 MS volunteers) was performed to measure XO, superoxide dismutase (SOD), glutathione peroxidase activities, lipid peroxidation, high-sensitivity C-reactive protein (hsCRP) content, glucose levels, and lipid profile. Body mass indices, abdominal circumference, systolic and diastolic blood pressure, and TG levels were also determined. The exercise session consisted of 3 minutes of stretching, 3 minutes of warm-up, 30 minutes at a constant dynamic workload at a moderate intensity, and 3 minutes at a low speed. The blood samples were collected before and 15 minutes after the exercise session., Results: Serum XO activity was higher in MS group compared to control group. SOD activity was lower in MS subjects. XO activity was correlated with SOD, abdominal circumference, body mass indices, and hsCRP. The single exercise session reduced the SOD activity in the control group., Conclusions: Our data support the association between oxidative stress and risk factors for cardiovascular diseases and suggest XO is present in the pathogenesis of metabolic syndrome.

We evaluated the response of individuals with metabolic syndrome to lifestyle modification intervention and examined the influence of the 48867A>C (Asp358Ala) IL6R (rs2228145) polymorphism on this response. Participants were randomly divided into two groups: NI, nutritional intervention; NIE, nutritional intervention and exercise practice. Intervention lasted three months and participants completed a comprehensive evaluation and had blood collected for biochemical measurements. Eighty-two sedentary individuals with at least three criteria for metabolic syndrome were included. Comparing metabolic syndrome parameters before and after intervention, a reduction of waist circumference was observed, although significant only for AA and AC genotypes. Also, a decrease in triglyceride levels was observed (significant for AA genotype individuals; for the AC genotype, only in the NIE group). Significant reduction of fasting glucose level was observed in all AA genotype individuals; for the AC genotype, only in the NI group. Systolic blood pressure showed significant reduction in AA and AC genotype individuals. After three months of lifestyle modification intervention, improvement in some of the metabolic syndrome parameters was observed, some associated with the IL6R genotype. At enrollment, participants with genotypes AA and AC showed more severe conditions regarding metabolic syndrome inclusion criteria, supporting previous reports that the A allele is a genetic risk factor. These individuals, however, had a better response to intervention compared to individuals with the CC genotype, suggesting that nutritional control and exercise practice could prevent risks associated with metabolic syndrome more efficiently in individuals bearing the A allele.

Objectives: To analyze the impact of blood transfusion on the incidence of clinical outcomes postoperatively (PO) from cardiac surgery., Methods: Retrospective cohort study. We analyzed 4028 patients undergoing coronary artery bypass grafting (CABG), valve (TV), or both, in Brazilian tertiary university hospital between 1996 and 2009. We compared the postoperative complications between patients with blood transfusion (n = 916) and non-blood transfusion (n = 3112). Univariate analysis was performed using the Student t test, and multivariate logistic regression bivariate (stepwise forward). Were considered significant variables with P <0.05., Results: Patients who received blood transfusions had more infectious episodes as mediastinitis (4.9% vs. 2.2%, P <0.001), respiratory infection (27.8% vs 17.1%, P <0.001) and sepsis (6.2% vs. 2.5%, P <0.001). There were more episodes of atrial fibrillation (AF) (27% vs. 20.4%, P <0.001), acute renal failure (ARF) (14.5% vs 7.3%, P <0.001) and stroke (4.8% vs. 2.6%, P = 0.001). The length of PO hospital stay was higher in transfused (13 ± 12.07 days vs. 9.72 ± 7.66 days, P <0.001). However, mortality didn't differ between groups (10.9% vs. 9.1%, P = 0.112). The transfusion was shown to be a risk factor for: respiratory infection (OR: 1.91, 95% CI 1.59-2.29, P <0.001), AF (OR: 1.35, 95% CI 1.13-1.61, P = 0.01), sepsis (OR: 2.08, 95% CI 1.4-3.07, P <0.001), mediastinitis (OR: 2.14, 95% CI: 1.43-3.21, P <0.001), stroke (OR: 1.63, 95% CI 1.1-2.41, P = 0.014) and ARF (OR 1.8, 95% CI: 1.39-2.33, P <0.001)., Conclusion: The blood transfusion is associated with increased risk of infectious events, episodes of AF, ARF and stroke, as well as the increased length of hospital stay but not mortality.