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To classify functional capacity of people with difficult-to-treat asthma based on the International Classification of Functioning, Disability and Health (ICF).Fifty-seven patients underwent the Incremental Shuttle Walk Test (ISWT) to assess functional capacity, in order to categorize them functionally we used the ICF qualifiers. To qualify ISWT results the individual's impairment (i.e. percentage of distance walked in relation to the percentage of predicted) was analyzed. Additionally, body mass index (BMI); physical activity level (IPAQ); and pulmonary function were evaluated. In order to analyze the difference between functional capacity levels, two groups were compared (i.e. mild/moderate vs. severe impairment); therefore, the participants were matched according to age and BMI and the unpaired Student t test was used.Among the fifty-seven included individuals, only one (1.8%) presented mild functional capacity limitation, 12 (21.1%) moderate limitation and 44 (77.2%) severe limitation. There was a significant difference between the ISWT distance between groups (F = 0.217, p .001). The other variables did not present differences between the mild/moderate and severe groups.The ICF qualifiers were able to categorize the ISWT and classified the functional capacity limitation as mild, moderate and severe. Therefore, it has proved to be a useful clinical tool for evaluation, follow-up and clinical decision-making.

Chronic obstructive pulmonary disease (COPD) negatively impacts autonomic control of the heart rate, as assessed by time and frequency domains of heart rate variability (HRV) analysis. However, it is unknown whether symbolic dynamic analysis may identify cardiac autonomic impairment, and whether such nonlinear indices may be associated with disease severity, prognostic markers, perceived dyspnea and functional capacity in patients with COPD. The current study assessed cardiac autonomic modulation by symbolic analysis of HRV in patients with COPD compared with healthy controls. We recruited 54 COPD patients and 20 healthy controls. The interval between two successive R-wave peaks was calculated in the resting supine position. HRV was analyzed using symbolic markers and Shannon entropy (SE). The six-minute walk test (6MWT) was applied in a 30-m corridor. We found a lower 6MWT distance in patients with COPD compared with healthy controls (p

Objective: To compare the incidence of postoperative complications (PC) between diabetic and nondiabetic patients undergoing cardiovascular surgeries (CS). Methods: This is a retrospective cross-sectional study, based on the analysis of 288 medical records. Patients aged ≥ 18 years, admitted to the intensive care unit (ICU) between January 2012 and January 2013, and undergoing coronary artery bypass grafting (CABG) or vascular surgeries were included. The population was divided into those with and without type 2 diabetes mellitus (T2DM), and then it was evaluated the incidence of PC between the groups. Results: The sample included 288 patients, most of them being elderly (67 [60-75] years old) male (64%) subjects. Regarding to surgical procedures, 60.4% of them were undergoing vascular surgeries and 39.6% were in the postoperative period of CABG. The incidence of T2DM in this population was 40% (115), just behind hypertension, with 72% (208). Other risk factors were also observed, such as smoking in 95 (33%) patients, dyslipidemias in 54 (19%) patients, and previous myocardial infarction in 55 (19%) patients. No significant difference in relation to PC (bleeding, atrial fibrillation, cardiorespiratory arrest, and respiratory complications) between the groups was observed (P>0.05). Conclusion: T2DM has a high incidence rate in the population of critically ill patients submitted to CS, especially in the elderly. However, in this small retrospectively analyzed study, there was no significant increase in PC related to diabetes for patients undergoing CS.

During a flight, changes occur in the human body, whose possible reactions can influence the well-being and quality of health of medicine users, subject of scarce studies. The aim of this paper is to analyze the impacts and effects of medication use during air transport. Through a literature review and documentary research methodology, relevant facts about the precautions that should be taken regarding the use of medication in flights were considered. As a practical contribution, some important medications and their possible effects during flights are presented, as well as some warnings about medication interactions, and some advice for better quality air travel for the health of passengers and crew are given. As a theoretical contribution, this study gathers the scattered information presented in the literature about the problems that the use of medications during a flight can cause to the human body and possible recommendations. As social contribution, this study warns about the risks of self-medication, and establishes a basis for future discussions with society about the use of medication in flights. Durante un vuelo se producen cambios en el cuerpo humano, cuyas posibles reacciones pueden influir en el bienestar y la calidad de salud de los usuarios de medicamentos, tema de escasos estudios. El objetivo de este trabajo es analizar los impactos y efectos del uso de medicamentos durante el transporte aéreo. Mediante una revisión de la literatura y una metodología de investigación documental, se consideraron hechos relevantes sobre las precauciones que se deben tomar con respecto al uso de medicamentos en los vuelos. Como contribución práctica, se presentan algunos medicamentos importantes y sus posibles efectos durante los vuelos, así como algunas advertencias sobre las interacciones de los medicamentos y se dan algunos consejos para viajes aéreos de mejor calidad para la salud de los pasajeros y la tripulación. Como aporte teórico, este estudio recoge la información dispersa presentada en la literatura sobre los problemas que el uso de medicamentos durante un vuelo puede ocasionar al cuerpo humano y sus posibles recomendaciones. Como aporte social, este estudio advierte sobre los riesgos de la automedicación y sienta las bases para futuras discusiones con la sociedad sobre el uso de medicamentos en los vuelos. Durante um voo, ocorrem mudanças no corpo humano, cujas possíveis reações podem influenciar no bem-estar e na qualidade de saúde dos usuários de medicamentos, objeto de estudos escassos. O objetivo deste artigo é analisar os impactos e efeitos do uso de medicamentos durante o transporte aéreo. Por meio de revisão de literatura e metodologia de pesquisa documental, foram considerados fatos relevantes sobre os cuidados que devem ser tomados quanto ao uso de medicamentos em voos. Como contribuição prática, são apresentados alguns medicamentos importantes e seus possíveis efeitos durante os voos, bem como alguns alertas sobre as interações medicamentosas e alguns conselhos para viagens aéreas de melhor qualidade para a saúde dos passageiros e tripulantes. Como contribuição teórica, este estudo reúne as informações dispersas apresentadas na literatura sobre os problemas que o uso de medicamentos durante o voo pode causar ao corpo humano e possíveis recomendações. Como contribuição social este estudo alerta sobre os riscos da automedicação, e estabelece bases para futuras discussões com a sociedade sobre o uso de medicamentos em voos.

Objective: To compare the effects of continuous and resistance aerobic training at high intensity and resistance in women with breast cancer during chemotherapry treatment. Design: A randomized clinical trial. Forty patient’s diagnostics with breast cancer and undergoing chemotherapy. Will be recruited and randomized into two groups: (a) Combined training (continuous aerobic + resistance); (b) Combined training (high-intensity interval (IAI) + resistance). They will follow a protocol for inclusion One-Repetition Max Test (1RM), Grocery Shelving Task Test, Shuttle walk test incremental and the questionaries: Quality of life questionarie (EORTC QLQ-C30), Functional Assessment of Cancer Therapy Breast (FACT-B) e Brief Fatigue Inventory (BFI). The training protocol proposed for the study groups should be carried out for 8 weeks, three times a week on alternate days, totaling 24 training sessions. Conclusion: The focus of research in this area has predominantly been over the past two decades, focused on the effectiveness of exercise as an adjuvant strategy after cancer diagnosis. Observational studies indicate that physical exercise is directly linked to a reduction in the risk of cancer recurrence and mortality. We hypothesized that all the training protocols proposed to promote the benefits in health indicators in this study and potential for therapies for patients safely undergoing cancer treatment will present, but which protocol can still pursue the beneficial effect. Objetivo: Comparar los efectos del entrenamiento aeróbico continuo y resistido de alta intensidad y resistencia en mujeres con cáncer de mama durante el tratamiento con quimioterapia.Diseño: Un ensayo clínico aleatorizado. Cuarenta pacientes diagnosticadas de cáncer de mama y sometidas a quimioterapia. Serán reclutados y aleatorizados en dos grupos: (a) Entrenamiento combinado (aeróbico continuo + resistencia); (b) Entrenamiento combinado (intervalo de alta intensidad (IAI) + resistencia). Seguirán un protocolo para la inclusión del One-Repetition Max Test (1RM), el Grocery Shelving Task Test, el Shuttle walk test incremental y los cuestionarios: Quality of Life Questionnaire (EORTC QLQ-C30), Functional Assessment of Breast Cancer Terapia (FACT-B) e Inventario Breve de Fatiga (BFI). El protocolo de entrenamiento propuesto para los grupos de estudio deberá realizarse durante 8 semanas, tres veces por semana en días alternos, totalizando 24 sesiones de entrenamiento. Conclusión: El foco de investigación en esta área ha sido predominantemente en las últimas dos décadas, centrado en la efectividad del ejercicio como estrategia adyuvante después del diagnóstico de cáncer. Los estudios observacionales indican que el ejercicio físico está directamente relacionado con la reducción del riesgo de recurrencia y mortalidad por cáncer. Presumimos que todos los protocolos de capacitación propuestos para promover los beneficios en los indicadores de salud de este estudio y el potencial de las terapias para pacientes en tratamiento contra el cáncer se presentarán de manera segura, pero cuyo protocolo aún puede buscar el efecto beneficioso. Objetivo: Comparar os efeitos do treinamento aeróbio contínuo e resistido de alta intensidade e resistência em mulheres com câncer de mama durante o tratamento quimioterápico. Desenho: Um ensaio clínico randomizado. Quarenta pacientes com diagnóstico de câncer de mama e em tratamento quimioterápico. Serão recrutados e randomizados em dois grupos: (a) Treinamento combinado (contínuo aeróbico + resistido); (b) Treinamento combinado (intervalo de alta intensidade (IAI) + resistência). Eles seguirão um protocolo para inclusão de One-Repetition Max Test (1RM), Grocery Shelving Task Test, Shuttle walk test incremental e os questionários: Questionário de qualidade de vida (EORTC QLQ-C30), Avaliação funcional da terapia do câncer de mama (FACT-B ) e Inventário Breve de Fadiga (BFI). O protocolo de treinamento proposto para os grupos de estudo deve ser realizado durante 8 semanas, três vezes por semana em dias alternados, totalizando 24 sessões de treinamento. Conclusão: O foco de pesquisa nesta área tem sido predominantemente nas últimas duas décadas, focado na eficácia do exercício como estratégia adjuvante após o diagnóstico de câncer. Estudos observacionais indicam que o exercício físico está diretamente ligado à redução do risco de recorrência e mortalidade por câncer. Hipotetizamos que todos os protocolos de treinamento propostos para promover os benefícios nos indicadores de saúde deste estudo e potencial de terapias para pacientes submetidos a tratamento oncológico com segurança apresentarão, mas cujo protocolo ainda pode buscar o efeito benéfico.

Objective: This systematic review and meta-analysis updated the effects of photobiomodulation therapy (PBMT) on pain, the Foot Function Index (FFI), and the effects on fascial thickness in...

Aim was to identify critical load (CL) in young and elderly apparently healthy male cohorts. To contrast the metabolic, cardiovascular and perceptual responses on CL according to age. We evaluated 12 young (23 ± 3 years) and 10 elderly (70 ± 2 years) apparently healthy active males, who underwent: (1) 1 repetition maximum (1RM) test on a 45° Leg Press; (2) on different days, three high-intensity resistance exercise constant load tests (60%, 75% and 90% 1RM) until fatigue (Tlim). Absolute values of both the CL asymptote and curvature constant (kg) were significantly lower in elderly subjects (P

BACKGROUND The prognosis of Pulmonary Hypertension (PH) is directly correlated with the functional capacity (FC). The most common FC test is the 6-Minute Walk Test (6MWT), however, there is evidence to suggest that the 6MWT does not reflect the real FC in PH patients. AIM To compare physiological responses among three field walk tests and cardiopulmonary exercise testing (CPET) in patients with pulmonary hypertension (PH), and to determine the determinants of distance walked in the field walk tests. DESIGN Cross sectional study. SETTING Outpatient clinic. POPULATION 26 volunteers (49.8±14.6 years), WHO functional class II-III and a mean pulmonary artery pressure of 45 mmHg. METHODS Patients underwent three field walk test: 6MWT, incremental shuttle walk test (ISWT), and endurance shuttle walk test (ESWT) and CPET on different, non-consecutive days. The main outcome measures were heart rate and perception of effort at the peak of exercise. RESULTS The ISWT achieved maximum levels of effort without significant difference in any physiologic response compared to CPET. The physiological responses during ISWT were significantly higher than 6MWT and ESWT responses. CONCLUSIONS The ISWT produced the greatest physiologic response of the field tests safely for which reason it appears to be the most effective test to assess FC of PH patients. CLINICAL REHABILITATION IMPACT The self-paced characteristic of the 6MWT and lower physiologic responses compared to the CPET were the main reason for this test to be classified as submaximal in PH patients. The physiological responses during the ESWT were significantly lower than other field tests highlighting the need for more research on this test and other field test in PH patients.

Aim: To evaluate functionality based on International Classification of Functioning and Disability and Health (ICF) model, thus allowing the categorization of the functional profile of these individuals on field tests. Methods: A descriptive and exploratory cross-sectional study. Participated in this study 25 patients (64,12±11,83 aged) with ILD according to current guidelines of the American Thoracic Society (ATS) and European Respiratory Society (ERS) and with stable clinical condition for three months. Incremental Shuttle Walk Test (ISWT), 6-Minute Walk Test (6MWT), spirometry, bioimpedance and St George Respiratory Questionnaire (SGRQ), were performed to categorize FC according to the ICF qualifiers. Results: In relation to the SWTI: 9 patients were classify as “no problem”, 6 as “mild problem” and 9 as “moderate problem” and 1 as “severe problem”; according 6-MWT: were possible to classify 3 patients as “no problem”, 7 as “mild problem”, 12 as “moderate problem” and 3 as “severe problem”. There was a statistically significant difference in the score of all SGRQ domains, compared to other level of severity in the ISWT. No problem versus severe problem (DM=2618,33; CI 95%:396,05/4840,60;p Conclusion: The ICF qualifiers were useful for categorizing SWTI and 6MWT allowing classifying the functional capacity of individuals with different severity levels.

Background: Interstitial fibrosing lung disease (IFLD) affects the pulmonary parenchyma, decreasing pulmonary compliance, altering ventilatory mechanics and reducing the functional capacity of the individual. Studies have compared the clinical utility of field walking tests (6-min walk test - 6MWT); Incremental Shuttle Walk Test (ISWT) to assess exercise tolerance in patients with IFLD. Aim: The aim of this study was to compare the physiological variables presented in the field tests (6MWT, ISWT and Endurante Shuttle Walk Test - ESWT). Methods: Patients with a medical diagnosis of IFLD were recruited from specialized outpatient clinic, such as interstitial diseases. Patients were underwent to anthropometric evaluation, spirometry, application of dyspnea questionnaires, quality of life and level of physical activity. The patients performed 6MWT, ISWT and ESWT according to its guidelines. Results: Eighteen individuals of both sexes, age 62.71 ± 4.75 years, with mild pulmonary restriction. According to the predictive equations, 90.28% of predicted in the 6MWT and 70.04% in the ISWT, 7 subjects stopped during the 6MWT. Predicted HRmax was 79.22% in the 6MWT, 78% in the ISWT and 62.62% in the ESWT. Fourteen patients presented saturation Conclusion: The 6MWT proved maximum test behavior for this population, but only a functional capacity deficit was verified in the ISWT, according to the predictive equations.

Background: The autonomic nervous system (ANS) controls the airway caliber and a dysfunction of this system can contribute to the progressive worsening of asthmatic patients. Pulmonary rehabilitation programs are part of non-drug treatment for patients with pulmonary disease, however, the effects of resistance exercise and autonomic modulation are still unknown subjects in asthmatic patients. Aim: The aim of the study was to investigate the influence of resistance training on heart rate variability (HRV) in individuals with difficult-to-control asthma. Methods: The experimental protocol consisted of an initial and final evaluation: body composition, spirometry, exhaled Nitric Oxide (eNO) HRV evaluation (supine and stand positions), 1RM of the quadriceps femoris, hamstrings, pectoralis, latissimus dorsi, biceps and triceps and asthma control questionnaire (ACQ6). After the evaluations, the patients underwent resistance training for 12/week, with an intensity of 60-80% of 1RM, 3 series of 12 repetitions with a 5% increase in load weekly according to the patient9s tolerance. Results: Twenty-one clinical stable patientes were included in this study (aged 39.5±13.9), eNO (37.5±35.6). After the resistance training, there was improvement in ANS activity and supine-vagal balance in supine position LF: 39.2±17.8 / 19.8±5.9nu (p Conclusion: Patients with DTC asthma showed improved autonomic modulation after resistance training protocol.

RESUMO: Objetivo: verificar na literatura os efeitos de programas de suit therapy (ST) no desempenho motor e funcional de crianças com paralisia cerebral. Método: esta é uma pesquisa de revisão sistemática com meta-análise, cuja busca de artigos foi realizada em três bases de dados utilizando a combinação alternada da palavra-chave “cerebral palsy” com “occupational therapy”, “physical therapy” e “physical therapy modalities”. Os artigos foram submetidos à avaliação de qualidade metodológica por meio das seguintes escalas: PEDro Scale, Jadad Scale e Study of Quality. Resultados: a busca resultou em 4.060 artigos, dos quais 1.425 foram excluídos por terem sido publicados antes de janeiro de 2006, 3.005 por não serem ensaios clínicos e 818 por não abordarem programas de ST. Assim, somente cinco artigos foram incluídos neste estudo, dos quais apenas dois apresentaram homogeneidade metodológica. Os estudos apresentaram resultados adversos e não mostram evidência a favor da ST. Conclusão: este estudo evidencia a necessidade de mais pesquisas sobre vestimentas com elementos dinâmicos, visto que não foram identificados estudos que indiquem melhora significativa nas habilidades motoras de crianças com paralisia cerebral. Purpose: examine literature on the effects of suit therapy (ST) programs on motor and functional performance of children with cerebral palsy. Methods: this is a study of systematic review with meta-analysis, whose search of articles occurred in three databases using the alternated combination of the keyword “cerebral palsy” with “occupational therapy”, “physical therapy”, and “physical therapy modalities”. The articles were evaluated using three scales of methodological quality: PEDro Scale, Jadad Scale and Study of Quality. Results: the search resulted in 4,060 articles, from which 1,425 were excluded for having been published prior to January 2006, 3,005 because were not clinical trials, and 818 for not addressing suit therapy programs. Thus, only five articles were included in this study, from which only two showed methodological homogeneity. The studies showed controversial results and did not show any positive evidence in favor of ST. Conclusions: this study reveals the need for research on clothing with dynamic elements, since we did not identify any study indicating significant motor skill improvements in children with cerebral palsy. Objetivo: verificar na literatura os efeitos de programas com suit therapy (ST) no desempenho motor e funcional de crianças com paralisia cerebral. Método: esta é uma pesquisa de revisão sistemática com meta-análise, cuja busca de artigos foi realizada em três bases de dados utilizando a combinação alternada da palavra-chave “cerebral palsy” com “occupational therapy”, “physical therapy” e “physical therapy modalities”. Os artigos foram submetidos à avaliação de qualidade metodológica por meio das seguintes escalas: PEDro Scale, Jadad Scale e Study of Quality. Resultados: a busca resultou em 4.060 artigos, dos quais 1.425 foram excluídos por terem sido publicados antes de janeiro de 2006, 3.005 por não serem ensaios clínicos e 818 por não abordarem programas de ST. Assim, somente cinco artigos foram incluídos neste estudo, dos quais apenas dois apresentaram homogeneidade metodológica. Os estudos apresentaram resultados adversos e não mostram evidência a favor da ST. Conclusão: este estudo evidencia a necessidade de mais pesquisas sobre vestimentas com elementos dinâmicos, visto que não foram identificados estudos que indiquem melhora significativa nas habilidades motoras de crianças com paralisia cerebral.

The autonomic nervous system (ANS) plays an important role in modulating bronchial smooth muscle contractility, which is altered in cystic fibrosis (CF). A convenient approach to probe ANS regulation is the quantitative analysis of heart rate variability (HRV). The purpose of this study was to evaluate ANS regulation in children with CF and to investigate the influence of colonization by Pseudonomas aeruginosa via assessment of HRV in colonized CF (CCF) children and noncolonized CF (NCCF) children. Sixteen children with CF (7 CCF and 9 NCCF) and seven healthy age-matched control children were enrolled in the study. Heart rate was recorded for 10 min at rest in the supine and standing positions and HRV analysis was carried out using autoregressive spectral analysis. The CCF group was characterized by lower forced expiratory volume than NCCF, indicating an impairment of respiratory function. The HRV parameters further confirmed the possible sympathetic overactivity in CCF. Children with CF exhibited hyperactivity of the sympathetic nervous system. In particular, the CCF group presented a greater impairment of ANS modulation. Both CCF and NCCF children showed lower supine vagal activation in the HRV indices related to sympathetic activation and reduction of indices indicating vagal activity with the postural change from supine to standing when compared to the NCCF group.

Background In recent years, obesity has become one of the most important public health problems in the world, with a growing prevalence in both developed and developing countries. Recent studies show that sleep disturbances, especially obstructive sleep apnoea (OSA) may be a manifestation of metabolic syndrome (MetS). Although the association of OSA with the MetS is largely attributed to obesity, the exact pathophysiological mechanisms and their individual characteristics still need to be identified. This study investigated the prevalence and severity of syndrome Z in obese women with MetS on waiting list for bariatric surgery. Methods In this double-center cross-sectional study, female patients aged ≥18 years, stage III severe obesity with MetS, on waiting list for bariatric surgery were recruited. The diagnosis for MetS was made according to the criteria of the national cholesterol education program, adult treatment panel III. Clinical, anthropometric, demographic, biochemistry, and sleep measurements were collected. Correlations between continuous variables with sleep parameters were performed using the Pearson correlation test or Spearman correlation test. Results The mean age of 83 patients was 44.8 ± 11.2 years and mean BMI was 42.6 ± 8.1 kg/m2. There was a significant correlation between OSA and metabolic score (r = 0.336; P = 0.002), neck circumference (r = 0.218; P = 0.048), basal systolic blood pressure (r = 0.280; P = 0.01), total cholesterol (r = 0.277; P = 0.011) and abdomen circumference (r = 0.284; P = 0.009). The mean values of excessive daytime sleepiness were 10.5 ± 7 demonstrating a value considered normal for its presence. However, a high risk for OSA was observed in practically the entire population. It was observed that the prevalence of Syndrome Z (75.9%) increased significantly according to apnoea hypopnoea index (AHI) (P for trend Conclusions We can conclude that syndrome Z presents a high prevalence in a female population with MetS and a considerable severity according to the presence of OSA. Therefore, patients with MetS should be investigated for the presence of sleep disorders. Trial registration The study has been registered on ClinicalTrials.gov NCT02409160 and followed the standards of The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies

The aim of this study was to evaluate the effectiveness of acute application of LEDT in improving peripheral muscle performance during isometric exercise in patients with asthma. Eleven patients, with a mean age 38 ± 10, underwent a single LEDT and sham application in the femoral quadriceps’ dominant member (cluster with 50 LED λ = 850 nm, 50 mW, 15 s; 37.5 J), 48 h apart in a randomized crossover design. Before and after LEDT and sham application, the patients were submitted an isometric endurance test (60% of the maximum isometric voluntary contraction), up to the limit of tolerance simultaneous recording of surface electromyography. There were no statistically significant differences between groups at the time of contraction (before 41±14 versus 44±16; after 46±12 versus 45±20 s) during the isometric contraction test and inflammatory markers before and after a single LEDT application. A single application of LEDT in the parameters and dose according to the equipment used in the study were not able to promote differences in the time of contraction and the fatigue response in asthmatic patients. However, the chronic effects of LEDT application for improving muscle performance in these patients are unknown and may present different responses during applications for a long time.

[Purpose] This study evaluated the effect of Bilevel Positive Airway (BiPAP) on the autonomic control of heart rate, assessed by heart rate variability (HRV), in patients hospitalized with decompensated heart failure. [Subjects and Methods] This prospective cross-sectional study included 20 subjects (age: 69±8 years, 12 male, left ventricular ejection fraction: 36 ±8%) diagnosed with heart failure who were admitted to a semi-intensive care unit with acute decompensation. Date was collected for HRV analysis during: 10 minutes spontaneous breathing in the resting supine position; 30 minutes breathing with BiPAP application (inspiratory pressure = 20 cmH2O and expiratory pressure = 10 cmH2O); and 10 minutes immediately after removal of BiPAP, during the return to spontaneous breathing. [Results] Significantly higher values for indices representative of increased parasympathetic activity were found in the time and frequency domains as well as in nonlinear Poincaré analysis during and after BiPAP in comparison to baseline. Linear HRV analysis: standard deviation of the average of all R-R intervals in milliseconds = 30.99±4.4 pre, 40.3±6.2 during, and 53.3±12.5 post BiPAP. Non-linear HRV analysis: standard deviations parallel in milliseconds = 8.31±4.3 pre, 12.9±5.8 during, and 22.8 ±6.3 post BiPAP. [Conclusion] The present findings demonstrate that BiPAP enhances vagal tone in patients with heart failure, which is beneficial for patients suffering from acute decompensation.

PURPOSE Asthma is a chronic inflammatory condition characterized by bronchial hypersensitivity to endogenous or exogenous agents and variable airflow limitation, which is reversible either spontaneously or with the use of medication. The evaluation of functional capacity in these patients is commonly performed using field tests to gauge activity of daily living. However, the reliability of the symptom-controlled shuttle walk test has not yet been determined for individuals with difficult-to-control asthma. The aim of the present study was to determine the reliability of the shuttle walk test in patients with severe, difficult-to-control asthma. METHODS Forty-five patients were evaluated including lung function tests, the International Physical Activity Questionnaire (IPAQ), and the Asthma Control Questionnaire. The participants performed a shuttle walk test twice, with a 20-min rest period between tests. RESULTS The mean distance walked for this cohort was 330.5 m (range, 50-570 m) on the first walk test and 336.3 m (range, 60-571 m) on the second test. There was no statistical difference between the mean distances walked. The Bland-Altman plots of the 2 tests revealed a mean difference of -12.7 m, with a 95% CI of 37.9 to -63.2 m. Significant correlations were found between the distance walked in meters and the IPAQ (r = 0.36, P < .01) and distance in meters and muscle mass (r = 0.39, P < .009). CONCLUSION The shuttle walk test is reliable for individuals with difficult-to-control asthma and can be used in the evaluation of functional capacity.

Introduction: Pulmonary Rehabilitation (PR), is considered an important non-pharmacological therapy to improve exercise tolerance in patients with pulmonary diseases, moreover, electrophysical resources such as photobiomodulation(PBMT)has been the subject of study for PRprograms, with benefits such as delaying muscle fatigue and increasing exercise performance Aim: The objective was to evaluate the effects of PBMTbyLED associated with a resistance training (RT)protocol on peripheral muscle function of patients with difficult to control asthma(DTCA) Methods: 30patients underwent to 1RMtest, Bioimpedance, pulmonary function, cardiopulmonary exercise testing and the incremental shuttle walk test. After the assessments, patients were randomized into one of two groups including RTwith LEDplacebo or LEDactive. RTwas performed at an intensity of 60to80%of1RMwith three sets of ten repetitions and5%weekly increment based on patient tolerance. PBMTwas applied in the pectoralis, latissimusdorsi, bicepsbrachii, tricepsbrachii, quadriceps and tibial ischia, based on randomization.After12weeks’training subjects were evaluated again Results: After RT was found a significant difference in the delta between LEDTActive and LEDTPlacebo in this variables: 1RM(kg):Quadriceps (40.6±28.8;7.5±5.8), latissimus dorsi (40.9±31.3;11,7±6.0), Ischia Tibial(41.8±26.9;19.4±12.3), pectoral(43.2±34.6; 29.8±15.6), and biceps brachii(82.8±38.5;14.85±9.8);VO2max(9.35± 7.8;5.78± 4.6 ml/kg/min Conclusions: PBMT byLEDT in conjunction with RT significantly improved skeletal muscle strength and functional capacity in DTCA patients.

Introduction: The Berlin questionnaire (BQ) has been used to help identify patients at risk for obstructive sleep apnea (OSA) in primary care. The BQ may be a useful adjunct in medicine and sleep research, but little applied in a population of patients with Myasthenia gravis (MG). The presence of sleep disorders in patients with MG may adversely affect the mechanics of breathing in wakefulness and sleep. Currently, few studies in the scientific literature show the presence of respiratory sleep disorders in patients with MG. Some studies have shown poor sleep quality, excessive daytime sleepiness (EDS) and the presence of sleep­disordered breathing, while others have not observed a positive correlation. Objective: To determine the sensitivity of BQ to sleep apnea/hypopnea index (IAH) obtained from overnight standard polysomnography (PSG) and verify the presence of EDS in MG patients. Methods: The Epworth Sleepiness Scale (ESS) and the BQ were applied. After completing the questionnaires, the patients were submitted to PSG. Results: Twenty­two patients (17 women) were evaluated. The mean age was 49.13 ± 11.53. BQ identified 60% of patients as being at high risk for OSA. PSG showed that 54.5% of patients had AHI above 5 and 36.3% AHI above 15. The ESS showed that 68% of the patients presented a score above 10. Conclusion: Our study showed a considerable increase in EDS and The BQ proved good sensitivity to identify patients at risk for OSA in a population of patients with MG.

Introduction: Pulmonary Hypertension (PH) is a pathophysiologic process encompassing multiple clinical manifestations, the most common being cardiovascular and pulmonary systems. With increased medical treatment options in recent decades, the prognosis in those with PH has improved significantly, and the role of physical exercise in this population has been reconsidered. The value of exercise training in this population require further analysis which is the pupose of the current study. Aim: To compare the effects of combined aerobic and resistance training to aerobic training alone in relation to indicators of cardiorespiratory and musculoskeletal function in patients with PAH. Methods: 15 clinical stable PAH patients were included in this study [48.9(19) WHO functional class II-III, mean pulmonary artery pressure (PAPm)45mmHg] who underwent a clinical evaluation, cardiopulmonary exercise test, six-minute walk test (6MWT), and assessment of peripheral muscle strength. The combined traning group (n=15)and aerobic only group (n=15)participated in their respective protocols 2 sessions per week over 8 weeks. Results: After training, a significant difference was found in 6MWT distance (20.3±9.5;6.8±3.8)m; VO2(27.5±6.5; 14.4±6.1) ml/kg/min; VO2(AT)(27.2±12.3; 18.1±11.3) ml/kg/min; and 1RM=QD(64.8±50.2;27.5±14.8)(Kg) and Biceps(47.8±28.3;34.5±23.5)(Kg) Conclusions: After combined training the patients with PAH safely improve key markers of functional capacity more than aerobic training alone.

Background Several clinical effects have been attributed to the use of biofeedback (BF) as an adjuvant in the treatment of women with stress urinary incontinence (SUI). Objectives To determine whether BF is more effective than other interventions for women with SUI in terms of quantification of urine leakage, episodes of urinary loss, quality of life and muscle strength. Data sources Science Direct, Embase, MEDLINE, Pedro, SciELO, CINAHL and LILACS from January 2000 to February 2017. Study selection Randomised controlled trials (RCTs) addressing the effects of pelvic muscle floor training (PFMT) with BF for the conservative treatment of women with SUI. Data extraction and data synthesis Two independent assessors extracted data from articles. The risk of bias for individual studies was assessed using the Jadad scale and Physiotherapy Evidence Database (PEDro) scale. Mean differences (MD) and 95% confidence intervals were calculated and combined in meta-analyses. Results In total, 1194 studies were retrieved and 11 were included in this review. Only two RCTs demonstrated a low risk of bias according to the PEDro scale. The results demonstrated that PFMT with BF was no better than alternative interventions in terms of muscle strength measured using a perineometer. Limitations Low methodological quality of studies, heterogeneity of outcomes, and differences in implementation of intervention protocols and BF modalities. Conclusions PFMT with BF does not offer therapeutic benefits over alternative interventions (no training, PFMT alone and vaginal electrical stimulation) for the treatment of female SUI. Systematic review registration number PROSPERO CRD42017060780.

Objective: To develop predictive equations for respiratory muscle strength (RMS) in 5 to 10 year old children. Materials and methods: This was a cross-sectional study in which 148 children took part, including boys and girls between 5 and 10 years of age. They were evaluated using a respiratory disease questionnaire validated for Brazil, and then submitted to a spirometric and anthropometric evaluation. The RMS measurements were obtained by manovacuometry and consisted of the maximum respiratory pressures. All the evaluations were carried out on the same day by the same evaluator. Results: The predictive power of the equations (R2) was between 25 and 63%, and by applying Pearson's correlation test it was shown that the MIP and MEP of the boys and girls presented significant correlation with age, height and body mass. Thus the mathematical models were separated according to gender and the results submitted to multiple linear regression. A Bland-Altman visual analysis was also used to evaluate agreement between the proposed predictive values and those of other already existing MIP and MEP equations. Conclusion: The equations giving predictive values for the MIP and MEP in 5 to 10 year old children were shown to be reproducible.

Purpose: Children with liver impairment are likely to develop changes in autonomic nervous function and delay in motor development. The assessment and identification of these dysfunctions may allow an appropriate physiotherapeutic care. Method: Cross sectional study of 18 infants, 11 controls and 7 infants (post-liver transplantation) with an average age of 10 ± 4.5 months, was evaluated in pre- and post-liver transplant. All infants underwent to assessments of motor skills, body composition, chest and abdominal motion, and cardiac autonomic modulation was measured by heart rate variability. Results: Motor delay and malnutrition were found in all infants. The gravity index (PELD)—pediatric end-stage liver disease—showed a negative correlation with the Alberta Infant Motor Scale (r = 0.83, p = 0.01). In addition, reduced parasympathetic modulation was demonstrated by the rMSSD, SD1 and ApEn, pre- and post-transplant. Conclusion: Infants with liver disease, even after transplantation, have delay in motor development, as well as changes in their nutritional and autonomic dysfunction.

Physical inactivity and low resting heart rate variability (HRV) are associated with an increased cardiovascular deconditioning, risk of secondary stroke and mortality. Aerobic dance is a multidimensional physical activity and recent research supports its application as a valid alternative cardiovascular training. Furthermore, technological advances have facilitated the emergence of new approaches for exercise training holding promise, especially those methods that integrate rehabilitation with virtual gaming.The purpose of this study was to evaluate cardiac autonomic modulation in individuals with chronic stroke post-training using a virtual reality - based aerobic dance training paradigm.Eleven community-dwelling individuals with hemiparetic stroke [61.7( ± 4.3) years] received a virtual reality-based dance paradigm for 6 weeks using the commercially available Kinect dance video game "Just Dance 3." The training was delivered in a high-intensity tapering method with the first two weeks consisting of 5 sessions/week, next two weeks of 3 sessions/week and last two weeks of 2 sessions/week, with a total of 20 sessions. Data obtained for HRV analysis pre- and post-intervention consists of HRV for ten minutes in (1) supine resting position; (2) quiet standing. High-frequency (HF) power measures as indicators of cardiac parasympathetic activity, low-frequency (LF) power of parasympathetic-sympathetic balance and LF/HF of sympatho-vagal balance were calculated. YMCA submaximal cycle Ergometer test was used to acquire VOAfter training, participants demonstrated a significant improvement in autonomic modulation in the supine position, indicating an improvement in LF=48.4 ( ± 20.1) to 40.3 ( ± 8.0),The current study is the first to assess the effect of a virtual reality-based aerobic dance training paradigm on HRV among individuals with chronic stroke. Given that the paradigm used in this study improves cardiac autonomic control, future studies should incorporate dance as an adjuvant therapy into clinical treatment program and assess its long-term efficacy.

The aim of this study was to describe the required coefficient of friction (RCOF) curve pattern of a child with unilateral spastic cerebral palsy (USPC). A child with USCP and true equinus and a healthy age-matched child participated in this study. They walked barefoot at a self-selected pace along a carpeted path and over two force platforms. RCOF was obtained as the ratio between the tangential forces (FT), and the vertical ground reaction force, (FZ). The RCOF curve present different patters when the USCP child was compared with the control, mainly for the affected side where it was observed lower RCOF peaks and valley as respected the nonaffected side and control values.

Objective: Compare the effects of treadmill training and training with overground walking (both without partial weight support) on motor skills in children with cerebral palsy. Design: Randomized controlled clinical trial. Setting: Physical therapy clinics. Subjects: Thirty-six children with cerebral palsy (levels I–III of the Gross Motor Functional Classification System) randomly divided into two intervention groups. Interventions: Experimental group (17 children) submitted to treadmill training without partial weight support. Overground walking group (18 children) submitted to gait training on a fixed surface (ground). Training was performed for seven consecutive weeks (two sessions per week), with four subsequent weeks of follow-up. Results: Both groups demonstrated improvements on the 6-minute walk test (experimental group from 227.4 SD 49.4 to 377.2 SD 93.0; overground walking group from 222.6 SD 42.6 to 268.0 SD 45.0), timed up-and-go test (experimental group from 14.3 SD 2.9 to 7.8 SD 2.2; overground walking group from 12.8 SD 2.2 to 10.5 SD 2.5), Pediatric Evaluation Disability Inventory (experimental group from 128.0 SD 19.9 to 139.0 SD 18.4; overground walking group from 120.8 SD 19.0 to 125.8 SD 12.2), Gross Motor Function Measure-88 (experimental group from 81.6 SD 8.7 to 93.0 SD 5.7; overground walking group from 77.3 SD 7.0 to 80.8 SD 7.2), Berg Balance Scale (experimental group from 34.9 SD 8.5 to 46.7 SD 7.6; overground walking group from 31.9 SD 7.0 to 35.7 SD 6.8) after treatment. The experimental group demonstrated greater improvements than the overground walking group both after treatment and during follow up ( p < 0.05). Conclusion: Treadmill training proved more effective than training with overground walking regarding functional mobility, functional performance, gross motor function and functional balance in children with cerebral palsy.