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Purpose: To determine the effects of remote ischemic preconditioning (RIPC) on pulmonary gas exchange in people undergoing pulmonary surgery and discuss a potential role of RIPC in COVID-19. Method: A search for studies examining the effects of RIPC after pulmonary surgery was performed. RevMan was used for statistical analyses examining measures of A-ado2, Pao2/Fio2, respiratory index (RI), a/A ratio and Paco2 obtained earlier after surgery (i.e., 6–8 hours) and later after surgery (i.e., 18–24 hours). Results: Four trials were included ( N = 369 participants). Significant ( p 2 and RI (SMD −0.84 and SMD −1.23, respectively), and later after surgery on RI, Pao2/Fio2, and a/A ratio (SMD −0.39, 0.72, and 1.15, respectively) with the A-ado2 approaching significance ( p = 0.05; SMD −0.45). Significant improvements in inflammatory markers and oxidative stress after RIPC were also observed. Conclusions: RIPC has the potential to improve pulmonary gas exchange, inflammatory markers, and oxidative stress in people with lung disease undergoing lung surgery and receiving mechanical ventilation. These potential improvements may be beneficial for people with COVID-19, but further investigation is warranted.

Objective The role of inspiratory muscle performance in functional performance in patients with COVID-19 is poorly understood. The purpose of this study was to perform a longitudinal examination of inspiratory and functional performance from intensive care unit (ICU) discharge (ICUD) to hospital discharge (HD) and symptoms at HD and 1 month after HD in patients with COVID-19. Methods Thirty patients (19 men, 11 women) with COVID-19 were included. Examination of inspiratory muscle performance at ICUD and HD was performed with an electronic manometer which provided the maximal inspiratory pressure (MIP) and several other inspiratory measures. Examination of dyspnea and functional performance was performed at ICUD and HD with the Modified Borg Dyspnea Scale and the 1-minute sit-to-stand test (1MSST), respectively. Results The mean age was 71 (SD = 11) years, the mean length of ICU stay was 9 (SD = 6) days, and the mean length of hospital stay was 26 (SD = 16) days. Most of the patients were diagnosed with severe COVID-19 (76.7%) and had a mean Charlson Comorbidity Index of 4.4 (SD = 1.9), reflecting high comorbidity. The mean MIP of the entire cohort increased minimally from ICUD to HD (from 36 [SD = 21] to 40 [SD = 20] cm H2O), reflecting predicted values for men and women at ICUD and HD of 46 (25%) to 51 (23%) and 37 (24%) to 37 (20%), respectively. The 1MSTS score increased significantly from ICUD to HD (9.9 [SD = 7.1] versus 17.7 [SD = 11.1]) for the entire cohort but remained far below population-based reference values (2.5th percentile) for the majority of patients at ICUD and HD. At ICUD, MIP was found to be a significant predictor of a favorable change in 1MSTS performance (β = 0.308; odds ratio = 1.36) at HD. Conclusions A significant reduction in inspiratory and functional performance exists in patients with COVID-19 at both ICUD and HD, with a greater MIP at ICUD being a significant predictor of a greater 1MSTS score at HD. Impact This study shows that inspiratory muscle training may be an important adjunct after COVID-19.

The purpose was to determine the effect low-intensity training with blood flow restriction (LI-BFR) versus high-intensity aerobic training (HIT) on acute physiological and perceptual responses. The Cumulative Index to Nursing and Allied Health Literature, National Library of Medicine, Scopus, SPORTDiscus and Web of Science databases and the reference list of eligible studies were consulted to identify randomized experimental studies, published until July 4, 2022, that analyzed physiological or perceptual responses between LI-BFR versus HIT in healthy young individuals. Mean difference (MD) and standardized mean difference (SMD) were used as effect estimates and random effects models were applied in all analyses. Twelve studies were included in this review. During exercise sessions, HIT promoted higher values of heart rate (MD=28.9 bpm; p

BACKGROUND The prevalence of chronic obstructive pulmonary disease (COPD) is increasing worldwide, and at the same time it is associated with increased mortality and reduced quality of life. Efforts to build sustainable rehabilitation approaches to COPD treatment and prevention are crucial. The system of long-term pulmonary rehabilitation care is insufficient. The main reasons for the absence of these outpatient programs are the lack of experience, the lack of interest of insurance companies in secondary prevention programs, and the lack of healthcare facilities in large geographical areas. The possibility of at-home pulmonary rehabilitation models (telemonitoring and telecoaching) could solve this problem. CASE SUMMARY A 71-year-old man with severe COPD, Global Initiative for Obstructive Lung Diseases stage 3 underwent an 8-wk remotely monitored inspiratory muscle training with a device based on the test of incremental respiratory endurance method. Spirometry, body plethysmography, test of incremental respiratory endurance examination, 6-min walking test, body mass index, airflow obstruction, dyspnea, exercise capacity index, and subjective perception of dyspnea were performed as part of the initial and final examination. The patient performed training at home, and the physiotherapist monitored the patient remotely through a web application that allowed the physiotherapist to evaluate all training parameters in real-time and respond to any problems. After 8 wk of home training, there was a significant increase in all monitored values: maximal inspiratory pressure, a novel parameter sustained maximal inspiratory pressure, forced expiratory volume in 1 s, total lung capacity, forced vital capacity, peak expiratory flow, and inspiratory capacity. There was also an improvement in the perception of dyspnea according to the COPD Assessment Test and a modified Medical Research Council Breathlessness Scale, an increase in exercise tolerance according to the 6-min walking test, and a decrease in the exercise capacity index as a predictor of prognosis. CONCLUSION Respiratory telerehabilitation was greatly beneficial in a cooperative patient with COPD and may represent an alternative therapeutic approach to the increasing incidence of all lung diseases.

Magno F Formiga,1 Filip Dosbaba,2 Martin Hartman,2 Ladislav Batalik,2 Marek Plutinsky,3,4 Kristian Brat,3,4 Ondrej Ludka,4 Lawrence P Cahalin5 1Departamento de Fisioterapia, Universidade Estadual da Paraíba, Campina Grande, PB, Brazil; 2Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic; 3Department of Respiratory Diseases, University Hospital Brno, Brno, Czech Republic; 4Faculty of Medicine, Masaryk University, Brno, Czech Republic; 5Department of Physical Therapy, University of Miami – Miller School of Medicine, Coral Gables, FL, USACorrespondence: Filip Dosbaba; Ladislav BatalikDepartment of Rehabilitation, University Hospital Brno, Jihlavska 20, Brno 62500, Czech RepublicEmail dosbaba.filip@fnbrno.cz; batalik.ladislav@fnbrno.czBackground: Subjects with COPD frequently develop considerable weakness and deconditioning of the inspiratory musculature, which can be corrected with inspiratory muscle training (IMT). While rehabilitation centers may be able to provide IMT as part of the rather complex management of COPD, there is currently a lack of rehabilitation services in the Czech Republic. Remote IMT may then benefit subjects with COPD who are unable to attend or do not have access to rehabilitation programs. We aim at evaluating the utility of the test of incremental respiratory endurance (TIRE) as an at-home IMT method in subjects with COPD, while comparing the effectiveness of this novel training approach to the outcomes of traditional, threshold loading IMT protocols.Methods/Design: This prospective, randomized controlled trial will comprise 8 weeks of at-home IMT sessions with remote supervision followed by 4 months of unsupervised, independent IMT. Eligible subjects will be randomly assigned to one of the following three distinct home-based IMT protocols: (1) TIRE, (2) Threshold loading, and (3) Sham training. Subjects allocated to the TIRE group will train once daily using an advanced IMT electronic system (PrO2), while the other two groups will receive threshold devices. Study outcomes will include measures of inspiratory muscle strength and endurance, pulmonary function, COPD-specific symptomatology, functional exercise capacity, surrogate markers of mortality risk, mental health status and health-related quality of life.Discussion: While we acknowledge the value of threshold loading IMT protocols, we believe that the TIRE training method has the potential to provide additional clinical benefits in COPD given its sophisticated remote tracking system and ability to modulate all aspects of muscular performance, including not only strength but also endurance, power and work capacity, allowing users to achieve considerably higher inspiratory pressures throughout the full range of inspiration when compared to other more traditionally used IMT methods.Keywords: chronic obstructive pulmonary disease, pulmonary rehabilitation, telemedicine, quality of life, inspiratory muscle training, test of incremental respiratory endurance

Background Exercise training (ET) with blood flow restriction (BFR) is becoming increasingly popular, but the majority of BFR ET studies have evaluated skeletal muscle strength and hypertrophy. The favorable effect of BFR ET on skeletal muscle and the vasculature appears to improve aerobic capacity (AC) although conflicting results have been observed.Purpose: The purposes of this systematic review with meta- analysis were to examine the effects of aerobic ET with and without BFR on AC and to compare the effect of low-to-moderate aerobic ET with and without BFR to high-intensity aerobic ET with and without BFR on AC. Study design Systematic Review with Meta-analysis. Methods A comprehensive search for studies examining the effects of aerobic ET with and without BFR on AC was performed. Inclusion criteria were: (a) the study was conducted in healthy individuals, (b) there was random allocation of study participants to training and control groups, (c) BFR was the sole intervention difference between the groups. Results A total of seven studies (5 low-to-moderate ET and 2 high-intensity ET) were included in the meta-analysis providing data from 121 subjects. There was a significant standardized mean difference (SMD) of 0.38 (95% CI = 0.01, 0.75) in AC between the BFR and non-BFR groups of all seven studies (z = 2.01; p = 0.04). Separate analyses of the five low-to-moderate aerobic ET studies found similar results with aerobic ET with BFR eliciting a significantly greater AC (z = 2.47; p=0.01) than aerobic ET without BFR (SMD of 0.57; 95% CI = 0.12, 1.01). Separate analyses of the two high-intensity aerobic ET studies with and without BFR found no significant difference in AC between the groups (SMD of - 0.01; 95% CI = - 0.67, 0.64). Conclusion Aerobic ET with BFR elicits a significantly greater AC than aerobic ET without BFR in healthy young adults. However, low-to-moderate intensity aerobic ET with BFR elicited a greater improvement in AC than aerobic ET without BFR while high-intensity aerobic ET with BFR did not elicit an improvement in AC over high-intensity aerobic ET without BFR. Level of evidence 1a.

Este artigo tem o propósito de apresentar um procedimento inovador para o ramo da engenharia civil, no que se refere a serviços estruturais, a laje protendida e nervurada. O estudo foi realizado durante a reconstrução do Instituto Adventista de Manaus, localizado à Rua Marciano Armond, 1805 - Cachoeirinha, Manaus AM. O método utilizado foi laje protendida e nervurada para melhor aproveitamento de espaço na estrutura com número reduzido de pilares. As nervuras são conhecidas por contribuir para um melhor uso de materiais de concreto armado como o aço e o concreto, reduzindo assim, o peso da estrutura. Sendo mais pré-tensionado, este modelo junto com a protensão pode superar grandes vãos, promover maior flexibilidade de utilização, menor consumo de concreto e redução do custo final em relação à laje maciça padrão de concreto utilizados em geral. Esse estudo de caso foi dividido nas seguintes etapas: fundamentos históricos da protensão e nervura, explanação de conhecimentos sobre laje protendida e nervurada utilizando cordoalhas engraxadas e sua execução na reconstrução.

This work is a systematic review with meta-analysis OBJECTIVE: Evaluate the effect of electrical stimulation (ES) on skeletal muscle volume and spasticity in individuals with spinal cord injury (SCI).University of Brasilia, Brazil METHODS: Searches were conducted of the Cochrane Library, MEDLINE, CINAHL, PEDro, PsycINFO and EMBASE electronic databases for relevant articles published up to June 2018. No restrictions were imposed regarding the year of publication. The inclusion criteria were randomized controlled trials involving adults with SCI comparing ES to an active or passive control. Two independent reviewers extracted the data from the selected studies and methodological quality was assessed using the PEDro scale.The initial search led to the retrieval of 164 studies, seven of which met the eligibility criteria, but only six were included in the meta-analysis. The six studies comprised 104 patients with complete or incomplete SCI. In the two studies that investigated the use of ES on muscle volume of the lower limbs, the overall effect was statistically significant in patients with acute SCI (mean difference: 0.86; 95% CI: 0.04 to 1.69; p 0.04). Among the four studies that examined the use of ES for spasticity of the lower limb, the overall effect was non-significant (mean difference: 0.55; 95% CI: -0.31 to 1.41; p = 0.21).Electrical stimulation was found to be an effective method for increasing muscle volume in SCI patients, but had no effect on spasticity. Further investigation of the effect of ES on spasticity in SCI is needed.

Congenital muscular dystrophy with merosin deficiency (MDC1A) is characterized by an impairment of muscle fiber by partial or complete deficiency of α2 laminin, (merosin) an extracellular protein responsible for maintaining cellular structure. Biomechanical changes in the structures involved with the respiratory act can trigger respiratory muscle weakness and low resistance to fatigue, showing respiratory distress and other worsening lung function. In response to this, the effects of respiratory muscle training (RMT) have been explained over the years in the literature. Although the benefits of RMT are known, there is no defined consensus regarding protocols and type of RMT to be used in patientes with neuromuscular disorders, especially in children, due to the scarcity of studies conducted with this specific group of patients. Therefore, the presente study aims to determine the effects of a RMT protocol on respiratory muscle strength and peak expiratory flow of a patient with congenital muscular dystrophy with merosine deficiency. La distrofia muscular congénita con deficiencia de merosina (MDC1A) se caracteriza por un deterioro de la fibra muscular por deficiencia parcial o complete de laminina α2 (merosina), una proteína extracelular responsable de mantener la estrutura celular. El cambio em la biomecánica de las estructuras implicadas en e lacto respiratório puede desencadenar debilidad de los músculos respiratórios y baja resistência a la fatiga, mostrando dificultad respiratória y otros empeoramiento de la función pulmonar. En respuesta a esto, los efectos del entraniamento de los músculos respiratorios (EMT) se han explicado a lo largo de los años em la literatura. Aunque se conocen los beneficios de la TMR, no existe un consenso definido com respecto a los protocolos y el tipo de EMT a utilizar en pacientes com desórdenes neuromusculares, especialmente en niños. Dado lo anterior, el presente estudio tiene como objetivo determinar los efectos de un protocolo de EMT sobre la fuerza muscular respiratoria y la calidad de vida de um paciente con Distrofia Muscular Congénita (DMC) con deficiencia de merosina (DM). A distrofia muscular congênita com deficiência da merosina (MDC1A) é caracterizada por um comprometimento da fibra muscular pela deficiência parcial ou completa da laminina α2 (merosina) uma proteína extracelular responsável pela manutenção da estrutura celular. A alteração da biomecânica nas estruturas envolvidas com o ato respiratório pode desencadear fraqueza muscular respiratória e baixa resistência à fadiga, evidenciando quadros de desconforto respiratório e outros agravos da função pulmonar. Em resposta a isso, os efeitos do Treinamento Muscular Respiratório (TMR) têm sido explanados ao longo dos anos na literatura. Apesar de conhecidos os benefícios do TMR, não há um consenso definido em relação a protocolos e tipo de TMR a ser utilizado em pacientes com afecções neuromusculares, especialmente em crianças. Dado o exposto, o presente estudo tem por objetivo determinar os efeitos de um protocolo de TMR sobre a força muscular respiratória e qualidade de vida de paciente com Distrofia Muscular Congênita (DMC) com deficiência de merosina (DM).

Introduction Systemic arterial hypertension (SAH) is considered a multifactorial disease characterized by a persistent increase in blood pressure levels. Currently, the efficient control of blood pressure is achieved by both the use of pharmacological therapy and the control of risk factors. In addition, the use of biofeedback (BFB) as a non-pharmacological strategy represents a promising therapy. Objective This study aims to evaluate the effects of BFB on systolic and diastolic blood pressure levels, as well as on environmental and psychosocial factors in patients with essential SAH. Methods A systematic review (SR) of the literature was carried out in English and Portuguese using the following databases: SCIELO, LILACS, CINAHL, Cochrane, and PubMed. The search strategy included a mix of terms for the key concepts Biofeedback, Heart Rate Variability, Psychophysiological Feedback, and Heart Biofeedback. Studies were analyzed independently. Results The included studies evaluated a total of 462 subjects of both sexes. The meta-analysis revealed that BFB significantly elicited greater blood pressure control, mainly improving DBP levels (Z = 2.15; P = 0.03). Discussion Besides improvement in DBP readings post-intervention, BFB also resulted in better disease-related environmental and psychosocial factors, such as reduced stress levels. The magnitude of effect did not appear to depend on the type of BFB applied. Conclusion This SR demonstrated that BFB with visual and/or auditory information is a complementary option to pharmacological treatment in the management of individuals with systolic and diastolic arterial hypertension. Moreover, the use of this adjuvant therapy seems to facilitate better DPB control.

BACKGROUND: Exercise training (ET) with blood flow restriction (BFR) is becoming increasingly popular, but the majority of BFR ET studies have evaluated skeletal muscle strength and hypertrophy. The favorable effect of BFR ET on skeletal muscle and the vasculature appears to improve aerobic capacity (AC) although conflicting results have been observed. Purpose: The purposes of this systematic review with meta- analysis were to examine the effects of aerobic ET with and without BFR on AC and to compare the effect of low-to-moderate aerobic ET with and without BFR to high-intensity aerobic ET with and without BFR on AC. STUDY DESIGN: Systematic Review with Meta-analysis. METHODS: A comprehensive search for studies examining the effects of aerobic ET with and without BFR on AC was performed. Inclusion criteria were: (a) the study was conducted in healthy individuals, (b) there was random allocation of study participants to training and control groups, (c) BFR was the sole intervention difference between the groups. RESULTS: A total of seven studies (5 low-to-moderate ET and 2 high-intensity ET) were included in the meta-analysis providing data from 121 subjects. There was a significant standardized mean difference (SMD) of 0.38 (95% CI = 0.01, 0.75) in AC between the BFR and non-BFR groups of all seven studies (z = 2.01; p = 0.04). Separate analyses of the five low-to-moderate aerobic ET studies found similar results with aerobic ET with BFR eliciting a significantly greater AC (z = 2.47; p=0.01) than aerobic ET without BFR (SMD of 0.57; 95% CI = 0.12, 1.01). Separate analyses of the two high-intensity aerobic ET studies with and without BFR found no significant difference in AC between the groups (SMD of - 0.01; 95% CI = - 0.67, 0.64). CONCLUSION: Aerobic ET with BFR elicits a significantly greater AC than aerobic ET without BFR in healthy young adults. However, low-to-moderate intensity aerobic ET with BFR elicited a greater improvement in AC than aerobic ET without BFR while high-intensity aerobic ET with BFR did not elicit an improvement in AC over high-intensity aerobic ET without BFR. LEVEL OF EVIDENCE: 1a