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Objetivou-se avaliar a resistência aeróbia muscular periférica de idosos com Doença Pulmonar Obstrutiva Crônica (DPOC) e correlacionar com a capacidade funcional. Foram avaliados dados antropométricos e clínicos, capacidade funcional e resistência aeróbia muscular periférica, fixando-se o p≤ 0,05. A amostra foi composta por 14 indivíduos com DPOC, apresentaram London Chest Activity of Daily Living (LCADL) com índices de comprometimento, Teste de Caminhada de 6 minutos (TC6min) dentro da normalidade, escore de TGlittre abaixo dos valores de referência. TC6min e o TGlittre não apresentaram correlação significativa com o tempo de realização ou a quantidade de repetições do TPP. A avaliação da resistência muscular periférica através do TPP foi dificultada por não haver na literatura valores de referência para a faixa etária da população do estudo, porém foi encontrada uma correlação significativa moderada entre a escala LCADL com o número de repetições e o tempo do TPP.

To analyse the psychometric properties of the translated and cross-culturally adapted version of the OSAKA (Obstructive Sleep Apnea Knowledge and Attitudes) questionnaire in the Brazilian Portuguese language.The OSAKA instrument was translated by two independent translators, and the back-translated conciliated version was presented and approved by Washington University, which holds the intellectual property for the OSAKA questionnaire. Physicians from different specialties electronically completed the OSAKA instrument and the ASKME (Assessment of Sleep Knowledge in Medical Education) questionnaire, which was used as an auxiliary instrument to analyse the construct validity.The questionnaire was tested with 176 physicians. The items from the knowledge and attitudes domains presented acceptable internal consistency values, with McDonald's omega coefficients (Ω) of 0.70 and 0.73, respectively. The OSAKA questionnaire showed a moderate correlation with the ASKME instrument (r = 0.60, p 0.001) and excellent retest reliability, with an intraclass correlation coefficient of 0.81. There were differences in knowledge between the medical specialties (p 0.001). Regarding attitudes, most respondents considered obstructive sleep apnoea and its diagnosis to be important and felt confident in identifying it, but the same majority did not feel confident in treating the disease.The OSAKA instrument, as a translated and cross-culturally adapted Brazilian Portuguese version, presented psychometric properties with adequate reliability and validity.

OBJECTIVES: To examine older people’s preferences for self-involvement in end-of-life care decision-making in scenarios of mental capacity (competency) and incapacity, and to identify associated factors. METHODS: A cross-sectional survey was conducted including 400 individuals aged 60+ years living in the city of Belo Horizonte, Brazil. RESULTS: Among 400 respondents, 95.3% preferred self-involvement when capable (due to the high percentage, associated factors were not calculated) and 64.5% preferred self-involvement when incapable through, for example, a living will. Considering that participants could choose multiple answers, the most frequent combinations in the capacity scenario were “yourself” and “other relatives” (76.8%) and “yourself” and “the doctor” (67.8%). In the incapacity scenario, the most frequent combinations were “yourself” and “other relatives” (usually their children and, less often, their grandchildren) (59.3%) and “yourself” and “the doctor” (48.5%). Three factors were associated with a preference for self-involvement in an incapacity scenario. Those who were married or had a partner (widowed; adjusted odds ratio [AOR] = 0.37; 95% confidence interval [CI] 0.19–0.68) and those who were male (female; AOR = 0.62; 95%CI 0.38–1.00) were less likely to prefer self-involvement. Those who were younger, as in age bands 60-69 years (80+; AOR = 2.35; 95%CI 1.20–4.58) and 70–79 years (80+; AOR = 2.45; 95%CI 1.21–4.94), were more likely to prefer self-involvement. CONCLUSIONS: Most participants preferred self-involvement in both scenarios of capacity and incapacity. Preference for self-involvement was higher in the scenario of capacity, while preference for the involvement of other relatives (usually their children) was greater in the scenario of incapacity.OBJECTIVE: To compare balance between older adults with and without chronic obstructive pulmonary disease (COPD) in tasks involving proprioceptive changes and respiratory muscle load, and to investigate the association between balance, functional capacity, and peripheral and respiratory muscle strength. METHODS: Fourteen older adults with COPD undergoing pulmonary rehabilitation and nine older adults without pulmonary disease were evaluated for static balance on a force platform under four conditions: eyes open, eyes closed, eyes closed on foam, and eyes open with respiratory overload. Differences between groups, among conditions and group/condition interactions, were tested using two-way ANOVA. Associations were explored using Pearson’s correlation coefficient. RESULTS: No differences in the posturographic variables were found in the group/condition interactions (p ≥ 0.23). The COPD group exhibited greater total displacement (F = 8.79, p = 0.003), mediolateral sway (F = 4.01, p = 0.04) and anteroposterior velocity (F = 4.28, p = 0.04) in the group effect analysis. Significant differences were found between eyes closed on foam and other conditions for all posturographic variables: anteroposterior sway (F = 13.39), mediolateral sway (F = 28.58), total displacement (F = 59.4), area (F = 37.68), anteroposterior velocity (F = 26.42), and mediolateral velocity (F = 33.29), in the condition effect analysis (p < 0.001, post-hoc). In the COPD group, significant correlations were found between the Glittre-ADL test, anteroposterior sway (r = 0.68, p = 0.01), and anteroposterior velocity (r = 0.67, p = 0.009); the 6MWT was also correlated with anteroposterior velocity (r = 0.59, p = 0.03). CONCLUSION: Older adults with COPD present balance deficits compared to healthy individuals. The unstable surface caused greater postural instability compared to other conditions in both groups. Impaired balance was associated with reduced physical function and exercise capacity.

Introduction: Work-related musculoskeletal disorders affect the performance of workers and can increase presenteeism, a condition in which the employee comes to the workplace but does not produce satisfactory results because he is ill. Objective: To identify the prevalence of musculoskeletal symptoms and its association with presenteeism among public health management professionals of Belem-PA, Brazil. Methods: Cross-sectional study carried out with 88 professionals from the Municipal Health Department of Belem. A sociodemographic questionnaire was used to characterize the sample; the Nordic Musculoskeletal Questionnaire to identify the prevalence of pain, numbness, and tingling symptoms in the body; and the Stanford Presenteeism Scale to characterize presenteeism. Associations between variables were analyzed using a 5% significance level. Results: Musculoskeletal symptoms in the upper and lower back were the most prevalent. Presenteeism was significantly associated with daily workload, physical activity, and the presence of diagnosed musculoskeletal diseases or injuries. In the past 12 months, musculoskeletal symptoms in the neck, upper and lower back, wrists/hands, and hips/thighs have been associated with presenteeism. In the past 7 days, presenteeism has been associated with symptoms in the upper back and lower back. Conclusion: The most prevalent musculoskeletal disorders in health management professionals are associated with presenteeism.

Objective: To analyze whether maternal, obstetric, anthropometric data of the neonate and respiratory variables influence the use of BHMs in neonates admitted to the NICU. In addition, to evaluate the impact of the applicability of this type of technique on the morbidity, mortality and survival of these neonates. Methods: Retrospective, quantitative study with descriptive and inferential analysis. Initially, the sample consisted of 599 medical records. The study involved newborns of both sexes admitted to the Neonatal Intensive Care Unit (NICU) of the tertiary referral hospital at maternal and child health, during 2017. The respiratory variables, maternal, obstetric, data of the neonate, morbidity and mortality were selected. Results: BHMs were associated with neonates whose mothers had a number of pregnancies ≥ 3 or newborns who had cephalic presentation at the time of delivery. In addition, there are particularities among neonates who receive this intervention, such as higher capillary glycemia, lower head circumference and occurrence of jaundice. The technique was not related to prematurity factors, such as pregnancy time ≤ 24 weeks, or respiratory factors, such as apnea, flapping of the nose wing, cyanosis and intercostal retraction. However, the use of the BHMs increases neonatal survival and reduces the mortality. Conclusion: The BHMs use is determined by maternal, obstetric and neonatal variables, being determinant to reduce the risk of death and increase the survival in NICU. RESUMO Objetivo: Analisar se dados maternos, obstétricos, antropométricos e variáveis respiratórias influenciam o uso de BHMs em neonatos internados em UTIN. Além disso, avaliar o impacto da aplicabilidade desse tipo de técnica na morbimortalidade e sobrevida desses neonatos. Métodos: Estudo retrospectivo, quantitativo com análise descritiva e inferencial. Inicialmente, a amostra era composta por 599 prontuários. O estudo envolveu recém-nascidos de ambos os sexos internados na Unidade de Terapia Intensiva Neonatal (UTIN) do hospital terciário de referência em saúde materno-infantil, durante 2017. Foram selecionadas as variáveis respiratórias, maternas, obstétricas, dados do neonato, morbimortalidade.Resultados: os BHMs foram associados a neonatos cujas mães tiveram um número de gestações ≥ 3 ou recém-nascidos que apresentaram apresentação cefálica no momento do parto. Além disso, existem particularidades entre os neonatos que recebem essa intervenção, como aumento da glicemia capilar, menor perímetro cefálico e ocorrência de icterícia. A técnica não foi relacionada a fatores de prematuridade, como tempo de gestação ≤ 24 semanas, ou fatores respiratórios, como apneia, batimento da asa nasal, cianose e retração intercostal. Porém, o uso dos BHMs aumenta a sobrevida neonatal e reduz a mortalidade. Conclusão: O uso de BHMs é determinado por variáveis maternas, obstétricas e neonatais, sendo determinante para reduzir o risco de óbito e aumentar a sobrevida em UTIN.

Objetivo: Avaliar a performance muscular respiratória de idosos fisicamente ativos praticantes de modalidades de exercícios terrestres e aquáticas. Métodos: Estudo transversal, incluindo 30 idosos divididos igualmente em dois grupos, o grupo de atividade aquática (GA) e de atividade terrestre (GT). Foram avaliados dados antropométricos (altura, peso e IMC), a função pulmonar por meio da espirometria (VEF1, CVF e VEF1/CVF), a endurance muscular respiratória com o Power Breath K5 (S-Index, SIMP e exaustão) e os níveis de atividade física por meio de dois questionários (IPAQ e QBMI). Além disso, os dados foram expressos em média e desvio padrão, e os testes estatísticos (Shapiro-Wilk; t de Student; coeficiente de correlação de Pearson) foram realizados por meio do software R, versão 3.5.2, adotou-se o nível de significância de p≤0,05. Resultados: Identificou-se diferença estatística apenas nos parâmetros peso, IMC e nas médias de exaustão dos grupos estudados (p≤0,05). Conclusão: A endurance muscular respiratória de idosos que praticam atividades aquáticas é mais efetiva do que naqueles que praticam apenas atividades terrestres.

Introduction: The Glittre-ADL (TGlittre) test was developed to assess functional capacity in a group of activities of daily living, but little is known about the physiological responses expected during its implementation. Objective: To evaluate the physiological responses induced by TGlittre in COPD patients and compare them with those induced by the 6-minute walk test (6MWT). Method: This is a cross-sectional study involving 15 elderly patients with COPD (70±6 years and predicted FEV1 of 47±16%). The TGlittre and 6MWT were performed on two different days, evaluating heart rate, peripheral oxygen saturation and perceived exertion in the 1st, 4th and 6th minutes of the 6MWT and at the start, after each lap and the end of TGlittre. After the normality test (Shapiro-Wilk), the Wilcoxon test was applied to compare the functional tests, and Spearman’s correlation coefficient to assess the association between variables. Results: At the end of TGlittre, heart rate was faster than in the 6MWT (106.7±21.9 vs 96.4±16.2bpm, p = 0.02). The other physiological variables were similar at the end of both tests. Heart rate at the end of TGlittre correlated with the final heart rate in the 6MWT (r = 0.69; p = 0.002). Conclusion: TGlittre induced a faster heart rate than in the 6MWT, with increased metabolic demand, but with similar ventilatory responses.

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.

Este documento procura esclarecer quanto à utilização de oxigênio suplementar (oxigenoterapia), e suas formas de administração, para o tratamento da insuficiência respiratória aguda causada pela COVID-19. Recomenda-se o início da oxigenioterapia com fluxo de 5L/min com alvo de SpO2 ? 94% para pacientes com algum sinal de instabilidade clínica e alvo de SpO2 ? 90% quando o paciente estiver estável ou SpO2 ? 92% para gestantes. Recomenda-se a utilização de cateter nasal de oxigênio com até 5L/min sem necessidade de umidificação e não se recomenda a utilização de máscaras de Venturiâ. Se o paciente não atingir a SpO2 alvo, recomenda-se ajustar o fluxo de O2 entre 10 e 15 L/min com máscara reservatório não reinalante. O posicionamento da ASSOBRAFIR visa que o Fisioterapeuta adote estratégias de oxigenoterapia adequadas, auxiliando na sobrevida e demais desfechos negativos dos pacientes com COVID-19 e na prevenção das disfunções respiratórias e funcionais características desta infecção.

Summary Correspondence Gerson C. Junior, Campus Ceilandia – Universityof Brasilia, Centro Metropolitano 1, Conjunto A,Ceil^andia Sul – Ceil^andia – Brasilia, DF CEP72220-900 BrazilE-mail: cipriano@unb.br This study was conducted atthe Strength Training ResearchLaboratory of the Universityof Brasilia, Brazil. Accepted for publication Received 10 March 2014;accepted 28 November 2014 Key words cardiovascular responses; electrical stimulation;tonometry Purpose To investigate the effect of transcutaneous electrical nerve stimulation(TENS) on the arterial stiffness in healthy young adult and middle-aged menusing the augmentation index (AI-x) and hemodynamic measures.Methods Twenty-four men (12 aged 27 25 5 53 years and 12 aged54 83 5 10 years) were randomly allocated to two subgroups: TENS or placeboin ganglion region for 45 min. The AI-x and hemodynamic measures [late sys-tolic blood pressure (SBP), central blood pressure (CBP), difference between P1and P2 (DP) and tension time index (TTI)] were determined before and afterprotocols.Results TENS resulted in reduction of SBP in younger adults (TENSpre: 111 2;post: 105 2 2 mm Hg; PLACEBOpre: 113 1 8; post: 114 2 5 mm Hg;GEE, P

Cervical cancer (CC) is the most common type of cancer in women and is the third leading cause of death in most developing countries, causing more than 288,000 deaths in women worldwide each year. The most favourable survival rate is in developed countries, since CC mortality has recently declined in those countries. The purpose of this study was to determine the survival rate and associated factors of CC patients at a reference hospital in the Amazon region. The patient sample included records of 339 patients with cervical cancer who had been hospitalized in Belem, Para, Brazil from January 2005 to December 2010; the socioeconomic and clinical data were collected between June and September 2016. A survival rate of approximately 84% was observed, and it was found that disease stage (p

Economic growth, an aging population, and changes in lifestyle patterns have contributed to the rise in cardiovascular disease (CVD) in Brazil. Worksite health and wellness programs are viewed as a potentially viable means to address the increase in disease burden in Brazil. The purpose of the present review is to investigate actions proposed by the Brazilian Government for CVD prevention and the current state of worksite health promotion. Our review of literature found that the Brazilian Government has been showing a growing interest in developing and promoting CVD preventive strategies, primarily through better control of known risk factors (i.e. smoking, obesity, physical inactivity, high cholesterol, high blood pressure, and high blood glucose). Current initiatives are considered positive steps toward better CVD prevention in Brazil. With respect to worksite health and wellness, additional work is needed to determine optimal program delivery models, financial implications and individual/population compliance with healthier lifestyle choices.

Introduction: Participation in cardiovascular rehabilitation programs can influence the quality of life of elderly cardiac patients. Objective: To evaluate the impact of cardiac rehabilitation on the quality of life of the elderly. Methods: A systematic literature review was conducted through a bibliographic search of clinical trials published in English, Portuguese, Spanish, and Italian up to October 2011 in four databases (BVS, Medline, PEDro, and Cochrane). A search strategy using two terms at a time was employed with the following list of expressions: “cardiovascular rehabilitation” or “cardiac rehabilitation” and “quality of life”. Results: Of 684 studies found, 675 were excluded because they were not clinical trials that target elderly population (age ≥ 60 years), did not have quality of life as an outcome, or were not available in the cited languages. Conclusions: This review found that participation in cardiac rehabilitation programs produced positive impact on the quality of life of the elderly, the benefit being higher in subjects with advanced age.

CONTEXTUALIZAÇÃO: A medida de pressão expiratória máxima (PEmáx) possui algumas contraindicações, pois acredita-se que as respostas obtidas nessa medida são similares às respostas encontradas na manobra de Valsalva (MV). OBJETIVOS: O objetivo principal é avaliar a resposta da frequência cardíaca (FC) durante a medida da PEmáx e da MV em jovens saudáveis, em diferentes posturas, para identificar se e em qual condição a PEmáx reproduz as respostas obtidas na MV e, adicionalmente, estimar o trabalho realizado nas manobras. MÉTODO: Doze jovens saudáveis foram avaliados, orientados e familiarizados com as manobras. A MV foi composta por um esforço expiratório (40 mmHg) durante 15 segundos contra um manômetro. A PEmáx foi executada segundo a American Thoracic Society. Ambas as medidas foram realizadas nas posturas supino e sentado. Para a análise da variação da frequência cardíaca (∆FC), índice de Valsalva (IV), índice da PEmáx (IPEmáx) e o trabalho estimado das manobras (Wtotal, Wisotime, Wtotal/∆FCtotal e Wisotime/∆FCisotime ), utilizou-se ANOVA two-way com post-hoc de Holm-Sidak (p

A pressão expiratória positiva nas vias aéreas (EPAP) é um recurso terapêutico que compreende uma inspiração seguida de expiração contra resistência. Sua aplicação promove ajustes no sistema cardiovascular, de maneira similar ao observado durante a manobra de Valsalva (MV). O objetivo deste estudo foi analisar a resposta da frequência cardíaca (FC) à MV e às diferentes formas de aplicação de EPAP a fim de identificar se e em qual condição esta técnica reproduz a resposta da FC observada na MV, em homens jovens aparentemente saudáveis. Foram estudados 10 sujeitos (24±3 anos; 25±3 kg/m²) que realizaram os procedimentos de MV e EPAP, aleatoriamente em dias diferentes. Na MV o esforço expiratório foi sustentado por 15 s (pressão oral de 40 mmHg [53,4 cmH2O]). Empregou-se duas técnicas de EPAP (isolada e terapêutica) contra 3 níveis de pressão (10, 15 e 20 cmH2O), aplicados aleatoriamente. As manobras foram repetidas três vezes com intervalo de cinco minutos. Considerou-se o maior valor de variação da FC (DFC) de cada manobra para análise. Empregou-se o teste Shapiro-Wilk para verificar a distribuição dos dados e ANOVA para medidas repetidas, com post-hoc de Fisher, considerando-se αThe expiratory positive airway pressure (EPAP) is a therapeutic resource that comprises an inspiration followed by expiration against resistance. During its application there were adjustments in the cardiovascular system, similar to those observed during the Valsalva maneuver (VM). The aim of this study was to analyze the heart rate (HR) response to VM and to different ways of EPAP application to identify if and in which condition this technique reproduces the HR response observed in the VM, in apparently healthy young men. Ten subjects (24±3 years, 25±3 kg/m²) performed randomly the VM and EPAP procedures on different days. The expiratory effort in VM was sustained for 15 s (oral pressure of 40 mmHg [53.4cm H2O]). Two EPAP techniques were employed (alone and therapeutic) against three pressure levels (10, 15 and 20 cmH2O), randomly applied. The maneuvers were repeated three times with five minutes interval. It was considered the greatest value of HR variation (DHR) for each maneuver analysis. Were used the Shapiro-Wilk test to analyze the data distribution and the ANOVA for repeated measures, with Fisher's post-hoc, considering α

O estudo visou avaliar o conhecimento de fisioterapeutas e graduandos em Fisioterapia sobre diagnóstico e atendimento de urgência à parada cardiorrespiratória. A amostra foi composta de 72 estudantes e 108 fisioterapeutas, dos quais 64 atuam no ambiente extra-hospitalar e 44 no ambiente hospitalar. Foi aplicado aos participantes um questionário sobre ressuscitação cardiopulmonar (RCP) baseado nas diretrizes da American Heart Association de 2005. As respostas foram analisadas estatisticamente. Quanto ao diagnóstico da parada cardíaca, os grupos comportaram-se de maneira semelhante, optando pela avaliação da"presença de pulso e respiração". Quanto à seqüência de atendimento da RCP, a seqüência preconizada foi corretamente indicada por 52,8% do grupo estudante, 65,9% do subgrupo hospitalar e 40,6% do subgrupo extra-hospitalar. Quanto à relação compressão/ventilação, apenas 4,1% do grupo estudante, ninguém do extra-hospitalar e 25% do subgrupo hospitalar indicaram a relação preconizada atualmente. Quase todos (94%) os participantes reconheceram a importância do conhecimento em RCP para o fisioterapeuta. Assim, a maioria dos atuais e futuros fisioterapeutas reconhecem a importância da RCP para sua atuação profissional, mas têm conhecimento insuficiente sobre o tema e apenas uma pequena parcela busca atualizar-se.This study aimed at assessing undergraduates' and physical therapists' knowledge on diagnosing and emergency treating cardiopulmonary arrest. Subjects were 72 students and 108 physical therapists - of which 64 were active in non-hospital environment and 44 in hospitals - who answered a questionnaire on cardiopulmonary resuscitation (CPR) based on the American Heart Association 2005 guidelines. Answers were statistically analysed. As to diagnosing cardiopulmonary arrest, groups behaved similarly, having chosen the option"absence of consciousness, pulse and breath". Concerning the pattern of CPR assistance, the recommended ABCD sequence was recognized by 52.8% of the students, 65.9% of the hospital subgroup, and 40.6% of the non-hospital subgroup; nobody of the latter, only 4.1% of the students, and 25% of hospital professionals indicated the currently recommended compression/ventilation ratio. Almost all (94%) participants acknowledged the importance of CPR knowledge in physical therapy practice. Thus, though most current and future physical therapists recognize the importance of CPR for their professional role, they have insufficient knowledge about the subject and only few of them seek to update their knowledge.

Background:Circulatory power (CP) and ventilatory power (VP) are indices that have been used for the clinical evaluation of patients with heart failure; however, no study has evaluated these indices in patients with coronary artery disease (CAD) without heart failure.Objective:To characterize both indices in patients with CAD compared with healthy controls.Methods:Eighty-seven men [CAD group = 42 subjects and healthy control group (CG) = 45 subjects] aged 40–65 years were included. Cardiopulmonary exercise testing was performed on a treadmill and the following parameters were measured: 1) peak oxygen consumption (VO2), 2) peak heart rate (HR), 3) peak blood pressure (BP), 4) peak rate-pressure product (peak systolic HR x peak BP), 5) peak oxygen pulse (peak VO2/peak HR), 6) oxygen uptake efficiency (OUES), 7) carbon dioxide production efficiency (minute ventilation/carbon dioxide production slope), 8) CP (peak VO2 x peak systolic BP) and 9) VP (peak systolic BP/carbon dioxide production efficiency).Results:The CAD group had significantly lower values for peak VO2 (p < 0.001), peak HR (p < 0.001), peak systolic BP (p < 0.001), peak rate-pressure product (p < 0.001), peak oxygen pulse (p = 0.008), OUES (p < 0.001), CP (p < 0.001), and VP (p < 0.001) and significantly higher values for peak diastolic BP (p = 0.004) and carbon dioxide production efficiency (p < 0.001) compared with CG. Stepwise regression analysis showed that CP was influenced by group (R2 = 0.44, p < 0.001) and VP was influenced by both group and number of vessels with stenosis after treatment (interaction effects: R2 = 0.46, p < 0.001).Conclusion:The indices CP and VP were lower in men with CAD than healthy controls. Fundamento:Os índices da Potência Circulatória (PC) e Potência Ventilatória (PV) têm sido utilizados para avaliação clínica de pacientes com insuficiência cardíaca, mas nenhum estudo avaliou esses índices em pacientes com Doença Arterial Coronariana (DAC).Objetivo:Caracterizar ambos os índices em pacientes com DAC comparados a indivíduos saudáveis.Métodos:Oitenta e sete homens [grupo DAC = 42 sujeitos e, grupo controle (GC) = 45 sujeitos] com idade entre 45 e 65 anos foram incluídos. Um Teste de Exercício Cardiopulmonar (TECP) foi realizado em esteira e as seguintes variáveis foram obtidas: 1) consumo de oxigênio (VO2) pico; 2) Frequência Cardíaca (FC) pico; 3) Pressão Arterial (PA) pico; 4) duplo produto pico (PA sistólica pico x FC pico); 5) pulso de oxigênio pico (VO2 pico dividido pela FC pico); 6) eficiência ventilatória para o consumo de oxigênio (OUES); 7) eficiência ventilatória para a produção de dióxido de carbono (VE/VCO2 slope); 8) PC (VO2 pico x PA sistólica pico); e 9) PV (PA sistólica pico dividido pelo VE/VCO2slope).Resultados:O grupo DAC apresentou valores significativamente menores das seguintes variáveis no pico do exercício: VO2 (p < 0,001), FC (p < 0,001), PA sistólica (p < 0,001), duplo produto (p < 0,001), pulso de oxigênio (p = 0,008), OUES (p < 0,001), PC (p < 0,001) e PV (p < 0,001), e valores significativamente maiores de PA diastólica (p = 0,004) e VE/VCO2 slope (p < 0,001) em relação ao GC. Uma análise de regressão pelo método stepwise mostrou que a PC foi influenciada pelo grupo (R2 = 0,44, p < 0,001) e a PV tanto pelo grupo quanto pelo número de vasos com estenose pós tratamento (efeito de interação: R2 = 0,46, p < 0,001).Conclusion:Os índices da PC e PV foram menores em homens com DAC comparados ao GC, podendo dessa forma ser utilizados na caracterização dessa população.

Background: Reduced respiratory muscle endurance (RME) contributes to increased dyspnea upon exertion in patients with cardiovascular disease. Objective: The objective was to characterize ventilatory and metabolic responses during RME tests in post-myocardial infarction patients without respiratory muscle weakness. Method: Twenty-nine subjects were allocated into three groups: recent myocardial infarction group (RG, n=9), less-recent myocardial infarction group (LRG, n=10), and control group (CG, n=10). They underwent two RME tests (incremental and constant pressure) with ventilatory and metabolic analyses. One-way ANOVA and repeated measures one-way ANOVA, both with Tukey post-hoc, were used between groups and within subjects, respectively. Results: Patients from the RG and LRG presented lower metabolic equivalent and ventilatory efficiency than the CG on the second (50± 06, 50± 5 vs. 42± 4) and third part (50± 11, 51± 10 vs. 43± 3) of the constant pressure RME test and lower metabolic equivalent during the incremental pressure RME test. Additionally, at the peak of the incremental RME test, RG patients had lower oxygen uptake than the CG. Conclusions : Post-myocardial infarction patients present lower ventilatory efficiency during respiratory muscle endurance tests, which appears to explain their inferior performance in these tests even in the presence of lower pressure overload and lower metabolic equivalent.

A pressão expiratória positiva nas vias aéreas (EPAP) é um recurso terapêutico que compreende uma inspiração seguida de expiração contra resistência. Sua aplicação promove ajustes no sistema cardiovascular, de maneira similar ao observado durante a manobra de Valsalva (MV). O objetivo deste estudo foi analisar a resposta da frequência cardíaca (FC) à MV e às diferentes formas de aplicação de EPAP a fim de identificar se e em qual condição esta técnica reproduz a resposta da FC observada na MV, em homens jovens aparentemente saudáveis. Foram estudados 10 sujeitos (24±3 anos; 25±3 kg/m²) que realizaram os procedimentos de MV e EPAP, aleatoriamente em dias diferentes. Na MV o esforço expiratório foi sustentado por 15 s (pressão oral de 40 mmHg [53,4 cmH2O]). Empregou-se duas técnicas de EPAP (isolada e terapêutica) contra 3 níveis de pressão (10, 15 e 20 cmH2O), aplicados aleatoriamente. As manobras foram repetidas três vezes com intervalo de cinco minutos. Considerou-se o maior valor de variação da FC (DFC) de cada manobra para análise. Empregou-se o teste Shapiro-Wilk para verificar a distribuição dos dados e ANOVA para medidas repetidas, com post-hoc de Fisher, considerando-se α

A estratégia prioritária nacional na Saúde Coletiva é a Saúde da Família (PSF), no entanto, é incipiente a participação de outros profissionais de saúde na atenção primária, além da Medicina e Enfermagem. O objetivo deste estudo foi realizar uma revisão sistemática da visão acadêmica do papel do fisioterapeuta na equipe de saúde da família (ESF). Foi realizada pesquisa bibliográfica no portal da Biblioteca Virtual em Saúde (BVS/Bireme/OPAS/OMS), de janeiro de 1994 a julho de 2009. A estratégia adotada foi o cruzamento dos seguintes descritores: Programa Saúde da Família, Saúde da Família, Saúde Coletiva, Saúde Pública, Fisioterapia (especialidades), Fisioterapia (técnicas), modalidades de fisioterapia. Dos 51 trabalhos localizados, 14 não estavam disponíveis. O restante foi analisado e sete foram selecionados por contemplarem os critérios de inclusão. Conclui-se que, apesar dos esforços, a fisioterapia ainda não possui uma definição clara em relação a sua atuação no PSF. Brazil's main strategy in public health is the Family Health Program; however, the participation of healthcare professionals other than physicians and nurses in primary care activities is incipient. The aim of this study was to perform a systematic review of the academic opinion regarding the physical therapist's role in the family health team. We performed searches in the Health Virtual Library (BVS/Bireme/PAHO/WHO) from January 1994 to July 2009. The adopted strategy was the intersection of the descriptors: Family Health Program, Family Health, Public Health, Physical therapy (specialties), Physical therapy (modalities). Of the 51 located studies, 14 were not available. The remaining studies were analyzed and seven were selected for respecting the inclusion criteria. It was concluded that, despite the efforts, the actions developed by the physical therapist in the Family Health Program are not clearly defined yet. La estrategia prioritaria nacional en la salud colectiva es la Salud de la Familia (PSF); sin embargo es incipiente la participación de otros profesionales de salud en la atención primaria más allá de Medicina y Enfermería. Este estudio realiza una revisión sistemática de la visión académica del papel del fisioterapeuta en el equipo de la Salud de la Familia con una investigación bibliográfica en el portal de la Biblioteca Virtual en Salud (BVS/Bireme/OPAS/OMS) de enero 1994 a julio 2009. La estrategia ha sido el cruce de los siguientes descriptores: Programa Salud de la Familia, Salud de la Familia, Salud Colectiva, Salud Pública, Fisioterapia (especialidades), Fisioterapia (técnicas), modalidades de fisioterapia. Los siete trabajos seleccionados muestran que, pese a los esfuerzos, la fisioterapia todavía no cuenta con una definición clara en relación a su actuación en PSF.

OBJETIVO: Traduzir e adaptar culturalmente para língua portuguesa o questionário Scoring of Patellofemoral Disorders. MÉTODOS: 40 participantes foram selecionados entre fisioterapeutas e indivíduos leigos. O procedimento de tradução para língua portuguesa foi baseado em métodos padronizados. A escala original passou por 7 etapas até se obter a versão final em português da Escala de Desordens Patelofemorais. Em cada teste participaram 40 indivíduos, sendo 20 indivíduos leigos e 20 fisioterapeutas. O nível de não compreensão aceitável foi de até 10% dos entrevistados. RESULTADOS: No 1º teste apenas as questões 3 não foram compreendidas por mais de 10% dos participantes entrevistados, ocasionando a reaplicação do questionário. Já no 2° teste, apenas duas questões foram compreendidas por 90% dos entrevistados e as demais questões compreendidas por mais de 90%, não ocorrendo dúvidas entre os fisioterapeutas. Utilizou-se então a 2ª versão em português como versão final para a Escala de Desordens Patelofemorais. CONCLUSÃO: A escala Scoring of Patellofemoral Disorders foi traduzida e a adaptada culturalmente para língua portuguesa, tendo como título em português, Escala de Desordens Patelofemorais. Nível de Evidência II. Estudos diagnósticos, Investigação de um exame para diagnóstico. AIM: The aim of this study was to translate and culturally adapt the questionnaire Scoring of Patellofemoral Disorders for the Portuguese language. METHODS: 40 participants were selected, including physiotherapists and lay individuals. The process of translating the questionnaire into Portuguese was based on standardized methods. The original scale passed through seven stages, before reaching the final version in Portuguese. 40 subjects took part in each test: 20 lay individuals and 20 physiotherapists. The level acceptable of non-comprehension was up to 10% of the interviewees. RESULTS: In the first test, only three questions were not understood by more than 10% of the subjects interviewed, leading to a reapplication of the questionnaire. In the second test, only two questions were understood by 90% of the interviewees, while the remaining question were understood by more than 90% of the interviewees, and there were no doubts among the physiotherapists. The 2nd version of the test was therefore selected as the final Portuguese version of Scoring of Patellofemoral Disorders. CONCLUSION: The Scoring of Patellofemoral Disorders scale was translated and adapted culturally for the Portuguese language, with title, in Portuguese, of Escala de Desordens Patelofemorais. Level of Evidence: Level II, development of diagnostic criteria on consecutive patients.

The study objective was to evaluate inspiratory muscle endurance in patients post-myocardial infarction without respiratory muscle weakness and its correlation with peak exercise capacity.Ten patients who recently had a myocardial infarction (recent infarction group [RIG]), 9 patients who less recently had a myocardial infarction (less recent infarction group [LIG]), and 12 healthy subjects (control group [CG]) underwent a cardiopulmonary exercise test and respiratory endurance protocol. Analysis of variance with post hoc Dunn comparisons was used to contrast performances on all tests, and Pearson's correlation was used to determine associations between variables.The RIG presented lower maximal incremental pressure and oxygen consumption than the CG (P.01). There was a positive correlation between peak oxygen uptake and both maximal inspiratory pressure (.68, P.001) and maximal incremental pressure (.65, P.001) in the RIG.The RIG showed lower maximal incremental pressure, which is related to peak exercise capacity. This novel relationship in functional capacity can indicate the need to improve muscle endurance in these patients even in the absence of inspiratory muscle weakness.

s / Autonomic Neuroscience: Basic and Clinical 163 (2011) 1–133 46 per day to achieve the goal BP. The repeat estimation of BRS was performed in 6 months of treatment. Results: At baseline spontaneous BRS in RHTN was significantly lower compared to controls (5.61±0.08 vs 6.60±0.10 ms/mm Hg; P

Background Cardiopulmonary exercise testing (CPX) is an important clinical assessment in patients with heart failure (HF). Neuromuscular electrical stimulation (NMES) has shown promise as an approach to improving cardiopulmonary performance during exercise and thus could improve key CPX measures. The primary aim of the proposed study is to perform a systematic review and meta-analysis on the effects of NMES on key CPX measures in HF patients. Methods Data sources : A systematic search without date or language restriction was conducted using Medline, Embase.com, Cochrane Central Register of Controlled Trials and CINAHL, Amedeo and PEDro. Study eligibility criteria : Randomized controlled trials, with or without crossover strategy, of NMES-based interventions and a comparison group submitted to usual medical care or exercise. Participants and interventions : Systolic HF patients; NMES-based interventions using skin electrodes to produce a muscle contraction. Study appraisal and synthesis methods : Studies were independently rated for quality (The Jadad Scale, PEDro Scale and The Quality of Research Score Sheet). Net changes were compared by weighted mean difference and 95% confidence interval. Heterogeneity among included studies was explored qualitatively and quantitatively. Begg's funnel plots and the Egger's regression assessed publication bias. Results Findings suggest that NMES provides similar gains in CPX performance compared to traditional exercise or usual treatment. Conclusions CPX performance has substantial prognostic and functional importance in the HF population. Our results suggest that NMES improves CPX performance and thus may be a valuable therapeutic intervention, positively altering the clinical trajectory of patients with HF.

INTRODUCTION: The limited number of valid and reliable questionnaires for the evaluation of exercise tolerance has stimulated the development of simple international assessment tools for this purpose, one of the most widely used of which is the Duke Activity Status Index (DASI). However, this index has not yet been translated and adapted to the Portuguese language. OBJECTIVE: To develop a Brazilian version of the DASI and cross-culturally adapt it for the evaluation of cardiorespiratory fitness among patients with cardiovascular disease in Brazil. MATERIALS AND METHODS: The translation process involved four stages: initial translation, back-translation, multidisciplinary committee review and pre-test with 16 subjects (8 cardiac patients and 8 healthy individuals). Patients were screened from outpatient Cardiac Surgery, São Paulo Hospital. The Mann-Whitney and chi-square tests were employed to determine differences between controls and individuals with heart disease. RESULTS: The sample was characterized by individuals aged ≥ 50 years who were mainly from the southeastern region of Brazil (62.5%) and were non-smokers (56.2%). Less than half of the cohort was considered physically active (43.75%). The level of non-understanding was less than 10% of the sample. Doubts were prevalent among individuals with heart disease (75%) regarding the level of fatigue caused when performing a task. CONCLUSION: The present findings demonstrate that the DASI was successfully translated and adapted to Brazilian Portuguese. INTRODUÇÃO: A limitação quanto ao uso rotineiro e em escala populacional dos métodos de maior acurácia para avaliação da capacidade incentivou o desenvolvimento de questionários de estimativa. O questionário Duke Activity Status Index (DASI) é um dos mais utilizados, no entanto ainda não traduzido e adaptado para língua portuguesa. OBJETIVO: Desenvolver uma versão brasileira do DASI e adaptá-lo culturalmente para avaliação da capacidade cardiorrespiratória de cardiopatas no Brasil. MATERIAIS E MÉTODOS: Foram realizadas quatro etapas metodologicamente recomendadas para esta finalidade: tradução inicial, tradução reversa, revisão por comitê multidisciplinar e pré-teste de verificação com 16 indivíduos (oito cardiopatas e oito saudáveis). Os pacientes foram triados no ambulatório da Cirurgia Cardíaca do Hospital São Paulo. Para verificar as possíveis diferenças entre os indivíduos saudáveis e cardiopatas foram utilizados os testes α Mann-Whitney ou qui-quadrado. RESULTADOS: A amostra foi caracterizada por indivíduos procedentes da região Sudeste (62,5%), não tabagistas (56,2%), ativos (43,75%) e com idade ≥ 50 anos. O nível de não compreensão aceitável foi de até 10% dos entrevistados. As dúvidas foram predominantes nos cardiopatas (75%) em relação ao grupo saudável (12,5%), sendo concentradas na consideração ou não do nível de cansaço para realizar a tarefa. CONCLUSÃO: Os resultados demonstram que o DASI foi satisfatoriamente traduzido e adaptado para a lingua portuguesa.