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This study aimed to establish availability and characteristics of cardiac rehabilitation (CR) in Latin America and the Caribbean (LAC), where cardiovascular disease is highly prevalent. In this cross-sectional sub-analysis focusing on the 35 LAC countries, local cardiovascular societies identified CR programs globally. An online survey was administered to identified programs, assessing capacity and characteristics. CR need was computed relative to ischemic heart disease (IHD) incidence from the Global Burden of Disease study. ≥1 CR program was identified in 24 LAC countries (68.5% availability; median = 3 programs/country). Data were collected in 20/24 countries (83.3%); 139/255 programs responded (54.5%), and compared to responses from 1082 programs in 111 countries. LAC density was 1 CR spot per 24 IHD patients/year (vs 18 globally). Greatest need was observed in Brazil, Dominican Republic and Mexico (all with >150,000 spots needed/year). In 62.8% (vs 37.2% globally P < .001) of CR programs, patients pay out-of-pocket for some or all of CR. CR teams were comprised of a mean of 5.0 ± 2.3 staff (vs 6.0 ± 2.8 globally; P < .001); Social workers, dietitians, kinesiologists, and nurses were significantly less common on CR teams than globally. Median number of core components offered was 8 (vs 9 globally; P < .001). Median dose of CR was 36 sessions (vs 24 globally; P < .001). Only 27 (20.9%) programs offered alternative CR models (vs 31.1% globally; P < .01). In LAC countries, there is very limited CR capacity in relation to need. CR dose is high, but comprehensiveness low, which could be rectified with a more multidisciplinary team.

Background Understanding patients’ perceptions about rehabilitation can guide healthcare administrators on modifications of program elements, which can ultimately improve cardiac rehabilitation (CR) use, adherence of heart-health behaviors, and improvements in clinical outcomes. Objective To examine the perception of patients about their participation in CR. Methods Qualitative study using semi-structured interviews, performed in a public CR center in Brazil. Twenty-eight patients were interviewed 2-years following participation in two CR models: exercise-based and comprehensive CR. Results Themes identified included: knowledge acquisition, improvement in functionality, and psychosocial well-being. It appeared that the perceived benefits of CR participation were overall positive and similar between the two models; however, those in the comprehensive CR identified additional subthemes: self-care need and knowledge transfer. Conclusions This study suggested that patients from two different CR models perceived in the long term that the CR participation positively impacted their disease-related knowledge, promoted functional gains, and improved psychosocial well-being. Structured educational interventions seemed to be associated with improved participants’ perception about CR, which could contribute to long-term maintenance of heart-health behavior and better outcomes.

PURPOSE: This study aimed to identify the characteristics of interventions employed to promote behavior change in people with type 2 diabetes mellitus (T2DM) and their impact on disease self-management and glycated hemoglobin (A1c). METHODS: The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used to guide the protocol development for this systematic review. Randomized controlled clinical trials which compared behavior change interventions to controls in adults with T2DM and investigated disease self-management and glycated hemoglobin (A1c) measured by validated methods were eligible for this study. The risk of bias and quality of evidence was assessed respectively by Cochrane’s tool and grading of recommendations, assessment, development, and evaluation (GRADE). RESULTS: A total of 27 studies were included involving 4464 participants. Behavior change was mainly promoted by education sessions on diabetes care delivered face-to-face, monthly, or every other month, lasting more than 60 min, involving blood glucose monitoring, healthy eating, exercise, and medication. Four studies showed significant improvement in both disease self-management and A1c. The risk of bias was classified as high in most studies. A meta-analysis could not be performed for A1c and self-management due to the high differences in intervention parameters (delivery mode, number, duration, and frequency) and self-management assessments. CONCLUSION: Low evidence of improvement in disease self-management and A1c considering only validated assessment methods were found for behavior change interventions, mainly promoted by education sessions on diabetes care. The quality of studies and probably the differences in intervention protocols contributed to this finding. PROSPERO NUMBER: CRD42020161162.

This cross-sectional study evaluated the perception of individuals with prediabetes/diabetes about their living conditions during the COVID-19 pandemic to identify the facilitators, barriers, and reasons to remain physically active at home and adhere to recommended exercise. It included individuals with prediabetes/diabetes who had completed an exercise intervention, which started on-site and moved to a remote home-based regime due to the COVID-19 pandemic and were advised to keep exercising at home. The outcomes were assessed by a bespoke questionnaire that was developed by the research team, the Brazilian Portuguese adapted version of the Exercise Adherence Rating scale, and the Motives for Physical Activity Measure-Revised scale. Of 15 participants (8 female, 58 ± 11 years), most reported positive perceptions about their living conditions and few difficulties maintaining some physical activity at home. However, only 53.8% of them adhered to the recommended exercise. Time flexibility, no need for commuting, and a sense of autonomy were the main facilitators of home exercise, while a lack of adequate space was the main barrier. The descending order of median scores that were obtained in each reason for physical activity was fitness, enjoyment, competence, social, and appearance. Individuals with prediabetes/diabetes maintained some physical activity during the pandemic, mainly motivated by health concerns.

Aerobic training can improve cardiorespiratory fitness in individuals after stroke. However, the effects of short-term and long-term detraining are not well known.To determine the effects of short-term (1-month) and long-term (6-month) detraining on cardiorespiratory fitness (VOA cohort study was developed. Twenty adults (57 ± 11 years old) with stroke were included. After completing an outpatient aerobic training, participants were divided into gain group (VOThere was found a significant interaction effect (time*group) for VODetraining on cardiorespiratory fitness of individuals after chronic stroke occurred within only 1 month. Therefore, it is important to maintain aerobic training throughout life.

PURPOSE The impact of comprehensive cardiac rehabilitation (CCR) in Latin America is not well known. Herein, the pre-specified tertiary outcomes of a cardiac rehabilitation (CR) trial are reported: disease-related knowledge, depressive symptoms, and heart-health behaviors (exercise, diet, and smoking). METHODS This was a single-blinded, single-center (Brazil) randomized trial with three parallel arms: CCR (exercise + education) versus exercise-only CR versus wait-list control. Eligible patients were randomized in blocks of four with 1:1:1 concealed allocation. The CR program was 6 mo long. Participants randomized to exercise-only CR received 36 exercise classes; the CCR group also received 24 educational sessions, including a workbook. All outcomes were assessed at pre-test and 6-mo later (blinded). Analysis of covariance was performed by intention-to-treat (ITT) and per-protocol (PP). RESULTS A total of 115 (89%) patients were randomized; 93 (81%) were retained. There were significant improvements in knowledge with CCR (ITT [51.2 ± 11.9 pre and 60.8 ± 13.2 post] and PP; P < .01), with significantly greater knowledge with CCR versus control (ITT mean difference [MD] = 9.5, 95% CI, 2.3-16.8) and CCR vs exercise-only CR at post-test (ITT MD = 6.8, 95% CI, 0.3-14.0). There were also significant improvements in self-reported exercise with CCR (ITT [13.7 ± 15.8 pre and 32.1 ± 2 5.7 post] and PP; P < .001), with significantly greater exercise with CCR versus control at post-test (ITT MD = 7.6, 95% CI, 3.8-11.4). Also, there were significant improvements in diet with CCR (PP: 3.4 ± 7.5 pre and 8.0 ± 7.0 post; P < .05). CONCLUSIONS In this first-ever randomized trial of CR for coronary artery disease in Latin America, the benefits of CCR have been supported.

Background Individuals with stroke have low physical activity levels and spend high amount of time in low-energy expenditure activities. Objective To investigate the effects of aerobic treadmill training on physical activity levels and time spent in low-energy expenditure activities (primary outcomes), as well as on cardiorespiratory fitness, endurance, depression, mobility, quality of life and participation (secondary outcomes) after stroke. Methods A randomized controlled trial, with 22 adults with chronic stroke was performed. Experimental group: aerobic treadmill training at 60-80% of heart rate reserve. Control group outdoor-overground walking below 40% of heart rate reserve. Both groups: three 40 min sessions/week over 12 weeks. Outcomes were measured at baseline, post-training, and 16-week follow-up. Results No changes in the primary outcomes were found for any of the groups. The experimental group showed greater improvements in quality of life at 16-week follow-up (13 points;95% CI:3.5-23). Both groups improved depression (2.2 points;95% CI:0.01-4.3), endurance (Six-minute walk test:31 m;95% CI:5.6-57, Incremental shuttle-walk test:55 m;95% CI:3.8-107), and mobility (0.12 m/s;95% CI:0.02-0.2). Conclusion Aerobic treadmill training improved quality of life. Aerobic treadmill training or outdoor-overground walking improved depression, endurance and mobility. Further studies are needed to clarify the effects of aerobic training on physical activity levels and time spent in low-energy expenditure activities after stroke.

RESUMO O objetivo deste estudo foi avaliar e comparar respostas metabólicas, cardiovasculares e ventilatórias do incremental shuttle walk test (ISWT) e do Glittre activities of daily living test (Glittre-ADL test). Trata-se de um estudo transversal, realizado com indivíduos saudáveis. A capacidade funcional (CF) foi avaliada pela distância percorrida e consumo de oxigênio pico (VO2pico) no ISWT e pelo tempo gasto e VO2 no Glittre-ADL test. Trinta indivíduos percorreram 656,67 (IC95%:608,8-704,5) metros no ISWT e executaram o Glittre-ADL test em 2,4 (IC95%:2,2-2,6) minutos. O VO2 pico do ISWT foi 27,8 (IC95%25,6-29,9) versus 22,2 (IC95%20,5-24,1)mL×kg−1×min−1 (p

Objetivo: comparar o nível de atividade física de idosos que sofreram ou não Infarto do Miocárdio (IM); investigar a relação entre o nível de atividade física mensurada por acelerômetro, nível autorrelatado e capacidade funcional mensurada por teste de caminhada e identificar a influência de fatores demográficos e clínicos no nível de atividade física mensurada. Método: foram incluídos idosos que tiveram IM, sendo eles divididos em dois grupos: grupo pós infarto do miocárdio (GPIM n=25) e grupo controle (GC n=20). A quantidade de atividade física foi mensurada por acelerômetro (counts/dia e steps/dia) e por autorrelato por meio do questionário Perfil de Atividade Humana (PAH). Também foi avaliada a distância percorrida no Incremental Shuttle Walk Test (ISWT). Resultados: observou-se que a quantidade de atividade física realizada nas duas formas mensuradas e a distância percorrida foram semelhantes nos dois grupos (p>0,05). Foi observada correlação moderada e significativa entre quantidade de atividade física medida pelo acelerômetro com a medida pelo PAH, assim como com a distância percorrida no ISWT. A análise de regressão linear múltipla mostrou que a idade e o número de fatores de risco para doença coronariana explicaram 39% da atividade realizada pelos idosos. Conclusões: embora a existência de IM prévio não tenha interferido na quantidade de atividade física, foi identificada associação dos fatores de risco para doença coronariana e idade com a atividade física diária. A distância caminhada no ISWT e o autorrelato do nível de atividade podem ser utilizados como bons indicativos do nível de atividade física diária de idosos.

INTRODUÇÃO: A doença arterial periférica (DAP) associa-se a alto risco de claudicação intermitente, sintoma que pode ser limitador da capacidade funcional do indivíduo. Nesse contexto, o Incremental Shuttle Walking Test (ISWT) representa o padrão-ouro para avaliação da capacidade funcional, entretanto possui limitações técnicas. O Duke Activity Status Index (DASI) é um questionário simples que abrange domínios relacionados à execução de tarefas diárias. OBJETIVO: avaliar a relação dos escores do DASI com a distância, a velocidade e o tempo atingidos no ISWT por indivíduos com DAP. MÉTODOS: Estudo observacional de corte transversal com amostra não probabilística. Os indivíduos com DAP foram selecionados e aplicou-se o ISWT e o DASI. Procedeu-se a análise descritiva dos dados utilizando o teste de Spearman para distribuição não normal adotando nível de significância de 5%. RESULTADOS: A análise estatística mostrou alta correlação entre ISWT e DASI em indivíduos com DAP. As variáveis distância percorrida, velocidade de marcha e tempo apresentaram forte correlação com o score DASI evidenciando o potencial de aplicabilidade do teste na prática clínica. CONCLUSÕES: Os resultados sugerem que o DASI pode ser utilizado na avaliação da capacidade funcional de indivíduos com diagnóstico de DAP, especialmente os que apresentam claudicação intermitente.

The primary objective of this study was to compare the effects on muscle metabolism of two types of aerobic training, with and without a load on the lower limbs, in adults with peripheral arterial disease (PAD). A simple blind randomized clinical trial was conducted using two groups: conventional aerobic (CG) and modified aerobic with a load on the lower limbs (MG). Both groups underwent training by walking three times a week over a 12-week period. The ratings of muscle metabolism were determined after a treadmill test with constant velocity and inclination concomitant with the use of near infrared spectroscopy (NIRS). Altogether 40 individuals with PAD (CG = 65.45 ± 10.60 and MG = 63.10 ± 10.54) were included in the study. After the intervention, in both groups, there was a reduction in the relative time to recovery (p = 0.002), an improvement in the re-oxygenation rate (p = 0.017), an increased time of resistance after reaching the lowest muscle oxygen saturation (StO2) (p 2 (p 2 on the treadmill after the intervention (p = 0.010). The traditional aerobic training was superior to the modified training in relation to the improvement of muscle metabolism in patients with PAD.

Publisher's version (útgefin grein), Background: Cardiac rehabilitation (CR) is a clinically-effective but complex model of care. The purpose of this study was to characterize the nature of CR programs around the world, in relation to guideline recommendations, and compare this by World Health Organization (WHO) region. Methods: In this cross-sectional study, a piloted survey was administered online to CR programs globally. Cardiac associations and local champions facilitated program identification. Quality (benchmark of ≥ 75% of programs in a given country meeting each of 20 indicators) was ranked. Results were compared by WHO region using generalized linear mixed models. Findings: 111/203 (54.7%) countries in the world offer CR; data were collected in 93 (83.8%; N = 1082 surveys, 32.1% program response rate). The most commonly-accepted indications were: myocardial infarction (n = 832, 97.4%), percutaneous coronary intervention (n = 820, 96.1%; 0.10), and coronary artery bypass surgery (n = 817, 95.8%). Most programs were led by physicians (n = 680; 69.1%). The most common CR providers (mean = 5.9 ± 2.8/program) were: nurses (n = 816, 88.1%; low in Africa, p < 0.001), dietitians (n = 739, 80.2%), and physiotherapists (n = 733, 79.3%). The most commonly-offered core components (mean = 8.7 ± 1.9 program) were: initial assessment (n = 939, 98.8%; most commonly for hypertension, tobacco, and physical inactivity), risk factor management (n = 928, 98.2%), patient education (n = 895, 96.9%), and exercise (n = 898, 94.3%; lower in Western Pacific, p < 0.01). All regions met ≥ 16/20 quality indicators, but quality was < 75% for tobacco cessation and return-to-work counseling (lower in Americas, p = < 0.05). Interpretation: This first-ever survey of CR around the globe suggests CR quality is high. However, there is significant regional variation, which could impact patient outcomes., This project was supported by a research grant from York University 's Faculty of Health. The funder had no role in study design, data collection, data analysis, interpretation or writing of the report.

ObjectiveCardiac rehabilitation (CR) availability, programme characteristics and barriers are not well-known in low/middle-income countries (LMICs). In this study, they were compared with high-income countries (HICs) and by CR funding source.MethodsA cross-sectional online survey was administered to CR programmes globally. Need for CR was computed using incident ischaemic heart disease (IHD) estimates from the Global Burden of Disease study. General linear mixed models were performed.ResultsCR was identified in 55/138 (39.9%) LMICs; 47/55 (85.5% country response rate) countries participated and 335 (53.5% programme response) surveys were initiated. There was one CR spot for every 66 IHD patients in LMICs (vs 3.4 in HICs). CR was most often paid by patients in LMICs (n=212, 65.0%) versus government in HICs (n=444, 60.2%; pConclusionCR is only available in 40% of LMICs, but where offered is fairly consistent with guidelines. Governments should enact policies to reimburse CR so patients do not pay out-of-pocket.

To investigate the concurrent validity of the Human Activity Profile (HAP) in individuals after stroke to provide the peak oxygen uptake (V̇oCross-sectional study.University laboratory.Individuals (N=57) aged 54±11 years who have experienced stroke.Not applicable.Agreement between the V̇oHigh magnitude agreement was found between the V̇oThe HAP questionnaire is a clinically applicable way to provide a valid value of V̇o

To evaluate the acute effects of expiratory positive airway pressure (EPAP) on exercise tolerance, dyspnea, leg discomfort, and breathing pattern in patients with COPD.Fifteen patients with COPD were assessed with the following three different protocols: EPAP of 7.5 cmHExercise tolerance was lower in protocol 1: 108 ± 45 seconds compared to protocols 2: 187 ± 99 seconds (A reduction on exercise tolerance and an increase in dyspnea were found with EPAP of 7.5 cm H

Background Cardiac rehabilitation (CR) is an established model of cardiovascular (CV) prevention that has proven benefits. Availability, characteristics and need of CR programs in Latin-American and Caribbean (LAC) countries remains poorly characterized. This study aims to establish the availability, capacity, density and aspects of CR delivery in LAC. Methods A cross-sectional survey was administered to CR programs in 24 LAC. Local CV organizations and societies identified CR programs. Characteristics of individual CR program were reviewed including: funding sources, core components, healthcare providers, and dose (number of sessions per weeks X total number of weeks) of CR. National CR capacity (median number of patients a program could serve per year X number of programs per country), density (Ischemic Heart Disease [IHD] incidence per year/ national capacity), need (IHD incidence per year- national capacity) and occupancy (median number patients program served per year/national capacity) were computed based on survey responses. Results At least one CR program was identified per LAC country (total 255 programs across 24 countries). Data was collected in 20 of the 24 countries. Responses were received from 139/255 programs (median program response rate=55%; Table 1). Over 50% (n=73) of programs were funded by multiple sources (government, hospital/clinic, private health insurance); Self-payment was reported by 63% programs, in which 24 (33.8%) patients paid over 50% of the cost. Guideline-indicated conditions were accepted in 77% or more programs. Physiotherapists (n=106, 76.3%), cardiologists (n=105, 75.5%) and dietitians (n=79, 56.8%) were the most common healthcare providers on CR teams. Regionally, programs offered 9 (IQR = 8–10) core components (patient education, exercise prescription and initial assessment delivered by nearly all programs). Median CR was 36 (IQR = 24–56) sessions/patient. Twenty-seven (20.9%) programs offered alternative CR models (e.g., home or community-based and hybrid models). Median national capacity was 500 CR spots/country (IQR= 200–2300). Regional density was 1 CR spot per 24 incident IHD patients per year. Greatest need in absolute terms for CR was observed in Brazil, Dominican Republic and Mexico (all with >150,000 spots needed per year to manage incident IHD patients; Table 1). Occupancy ranged from over 100% in Colombia to 15% in Chile (median=60%, IQR = 32%–81%), Table 1. Conclusion In LAC countries, there is very limited capacity to meet the need for CR. Nature of CR services varied regionally. Funding Acknowledgement Type of funding source: None

Background: Breathing pattern compasses the chest wall motion and its time and volume components. Aims: The primary objective of this study was to establish reference values for breathing pattern measured by optoelectronic plethysmography (OEP) of healthy individuals during quiet breathing in seated position. The secondary aim was to evaluate the influence of gender on breathing pattern parameters. Methods: 168 individuals (61 males, 52±21 years old, with normal lung function) were assessed by OEP during quiet breathing. Data were presented as mean and standard deviation.The comparisons between genders were performed by Student t test for independent samples, and Mann-Whitney, according to the characteristic and/or variable distribution. The study was approved by Ethics Committees. Results: Table 1 shows the reference values for five main variables among others parameters evaluated in seated position. Conclusions: Reference values for breathing pattern using OEP during quiet breathing were created through a multicenter study. In addition, the effect of gender was also evaluated, and showed that women had a more thoracic pattern of breathing and lower tidal volume compared with men. Sponsor: CAPES Brazil

Background: This study analyzes the current and evolving physical rehabilitation needs of BRICS nations (Brazil, Russian Federation, India, China, South Africa), a coalition of large emergent economies increasingly important for global health. Methods: Secondary, cross-national analyses of data on Years Lived with Disability (YLDs) were extracted from the Global Burden of Disease Study 2017. Total physical rehabilitation needs, and those stratified per major condition groups are analyzed for the year 2017 (current needs), and for every year since 1990 (evolution over time). ANOVAs are used to detect significant yearly changes. Results: Total physical rehabilitation needs have increased significantly from 1990 to 2017 in each of the BRICS nations, in every metric analyzed (YLD Counts, YLDs per 100,000 people, and percentage of YLDs relevant to physical rehabilitation, all p &lt, 0.01). Musculoskeletal &amp, pain conditions were leading cause of physical rehabilitation needs across the BRICS nations but to varying degrees: from 36% in South Africa to 60% in Brazil. Country-specific trends include: 25% of South African needs were from HIV-related conditions (no other BRICS nation had more than 1%), India had both absolute and relative growths of pediatric rehabilitation needs (p &lt, 0.01), China had an exponential growth in the per-capita needs from neurological and neoplastic conditions (p &lt, 0.01, r2 = 0.97), Brazil had a both absolute and relative growth of needs coming from musculoskeletal &amp, pain conditions (p &lt, and the Russian Federation had the highest neurological rehabilitation needs per capita in 2017 (over than three times those of India, South Africa or Brazil). Conclusions: total physical rehabilitation needs have been increasing in each of the BRICS nations, both in absolute and relative values. Apart from the common growing trend, each of the BRICS nations had own patterns for the amount, typology, and evolution of their physical rehabilitation needs, which must be taken into account while planning for health and physical rehabilitation programs, policies and resources.

RESUMO A avaliação da função dos músculos inspiratórios por meio do teste de endurance muscular inspiratória (EMI), definida como a capacidade de sustentação dessa tarefa ao longo do tempo, atualmente apresenta ampla variedade de instrumentos e procedimentos para sua mensuração. Este estudo teve como objetivo identificar os diferentes equipamentos, procedimentos e forma de avaliação dos testes de EMI entre fisioterapeutas brasileiros. É um estudo transversal realizado por meio de questionário enviado por correio eletrônico individualmente a cada participante. Cento e treze fisioterapeutas de diferentes regiões do país, grande parte com atuação conjunta na clínica e na docência (52,1%), responderam realizar poucas vezes a medida de EMI (48,7%). O manovacuômetro aneroide foi o aparelho mais utilizado por 42,5% dos profissionais. O clipe nasal e o bocal tubular de plástico rígido ou papel foram os acessórios mais utilizados durante o teste, correspondendo a 51,8% e 33%, respectivamente. O teste de ventilação voluntária máxima foi o mais utilizado para avaliação da endurance inspiratória, relatado por 23% dos respondentes. O teste de carga constante para avaliação da endurance foi adotado por 51,2% dos fisioterapeutas, sendo que 54,9% associaram comandos verbais à demonstração para explicação do teste. A interpretação dos valores aferidos era feita através de valores de referência por 25,7% dos entrevistados. Identificou-se que os fisioterapeutas brasileiros entrevistados não apresentaram a mesma conduta para os testes de EMI. No entanto os equipamentos, procedimentos e a forma de avaliação são utilizados com base nas diretrizes sobre o tema e de acordo com a disponibilidade de recursos do serviço.

Objective To track psychosocial well-being over 2 years following cardiac rehabilitation (CR) initiation, and its' association with heart-health behaviors. Methods Patients from 3 CR programs were approached at their first visit, and consenters completed a survey. Participants were emailed surveys again 6 months, 1 and 2 years later. Depressive symptoms (PHQ-8) and quality of life were assessed at each point, as were exercise, nutrition, smoking and medication adherence, among other well-being indicators. Results Of 411 participants, 46.7% were retained at 2 years. Post-CR, there was 70% concordance between participants' desired and actual work status. Depressive symptoms were consistently minimal over time (mean = 3.17 ± 0.37); Quality of life was high, and increased over time (p = .01). At 2 years, 56.9% participants met exercise recommendations, and 5.4% smoked. With adjustment, greater self-regulation was associated with significantly greater exercise at intake; greater exercise self-efficacy was significantly associated with greater exercise at 1 year; greater disease management self-efficacy was significantly associated with greater exercise at 2 years; greater environmental mastery (actual) was significantly associated with greater exercise at 2 years. Lower depressive symptoms were significantly associated with better nutrition at 2 years. Conclusion CR initiators are thriving, and this relates to better exercise and diet.

Objective Identify health literacy (HL) screening instruments available to CAD patients; describe the prevalence of low HL; explore the predictors of low HL; and, identify the association between HL, health behaviors, and outcomes among these patients. Methods A literature search of electronic databases was conducted for published articles from database inception to February 2017. Eligible articles included the assessment of HL in CAD patients. Health behaviors and outcomes included diet, exercise, smoking, medication use, hospital readmission, knowledge, health-related quality of life (HRQoL), and psychosocial indicators. Results Overall, ten articles were included, of which two were RCTs, and seven were considered “good” quality. The most used screening instruments were REALM and TOFHLA. The average prevalence of low HL was 30.5%. Low HL participants were more likely to be older, male, from a non-white ethnic group, have many CVD comorbidities, lower educational level, disadvantaged socioeconomic position, and less likely to be employed. Low HL was consistently associated with hospital readmissions, low HRQoL, higher anxiety and lower social support. Conclusion The literature on HL in CAD patients is very limited. Practice implications Healthcare providers should start adopting strategies that can potentially mitigate the impact of low HL in the care of CAD patients.

The Mediterranean Diet Scale (MDS) is a questionnaire with characteristics which can contribute to the multidimensional assessment of patients with diabetes mellitus (DM) by the multidisciplinary team, as well as to evaluate the effect of specific educational and nutritional interventions. The aim of this study was to translate and perform a cross-cultural adaptation of a Canadian MDS and analyze the measurement properties of the Brazilian Portuguese version of the Mediterranean Diet Scale (MDS-Brazil) in individuals with DM in Brazil.This was a cross-sectional study. The analyzed measurement properties were the internal consistency, floor and ceiling effects, reproducibility, and construct validity. The inclusion criteria were diagnosis of DM type 1 or type 2, literate, outpatients, and without eating restrictions.Of the 160 volunteers included in this study, 30 participated in pretesting, and another 130 (57.7% women, 74.6% DM type 2, 56.55 ± 14.88 years) agreed to participate in the evaluation stage of the measurement properties. All items were cross-culturally adapted. A factor analysis (KMO = 0.555 and X² = 137.22; p 0.001) extracted five factors, with no floor or ceiling effects, Cronbach's alpha = 0.42, and reproducibility ICC = 0.75.The cross-cultural adaptation was performed maintaining the equivalences. The MDS-Brazil measurement properties showed substantial reproducibility, low internal consistency, and fair correlations of construct validity in patients with DM.

BACKGROUND Cardiac rehabilitation (CR) programs can address the cardiovascular disease epidemic in South America. However, there are factors limiting CR access at the patient, provider, and system levels. The latter 2 have not been extensively studied. The objective of this study was to investigate cardiology administrator's awareness and knowledge of CR and perceptions regarding resources for CR. METHODS This study was cross-sectional and observational in design. Cardiology administrators from South American and Caribbean countries were invited to participate by members of a professional association. Participants completed a questionnaire online. Descriptive analysis was performed and differences in CR knowledge, awareness, perception, and attitudes regarding CR were described overall, by institution funding source (private vs public) and presence of within-institution CR (yes vs no). RESULTS Most of the 55 respondents from 8 countries perceived CR as important for outpatient care (mean ± SD = 4.83 ± 0.38 out of 5; higher scores indicating more positive perceptions), with benefits including reduced hospital readmissions (4.31 ± 0.48) and length of stay (4.64 ± 0.71 days), not only for cardiac patients but for those with other vascular conditions (4.34 ± 0.68 days). Those working in public institutions (50.9%) and in institutions without a CR program (25.0%) were not as aware of, and less likely to value, CR services (P < .05). Only 13.2% of programs had dedicated funding. CONCLUSIONS Similar to findings from high-income settings, cardiology administrators and cardiologists in South America value CR as part of cardiac patient care, but funding and availability of programs restrict capacity to deliver these services.

Highlights • Coronary artery disease (CAD) is one of the main causes of death. • The stress test is indispensable before cardiac rehabilitation. • The 6MWT is a simple, low-cost, valid, and reliable method. • The 6MWT can be used safely in the hospital after an AMI., Background The six-minute walk test (6MWT) is a simple, low cost, reliable, and valid method for evaluating the functional capacity of cardiac patients. However, its early use and safety following acute myocardial infarction (AMI) is recent and has been little investigated. Objective To evaluate and to compare the safety and the cardiac behavior of early performance of the 6MWT in patients following uncomplicated AMI up to 4 days or more than 4 days after the event. Methods Following discharge from the Coronary Care Unit, 152 stable asymptomatic patients diagnosed with uncomplicated AMI performed the 6MWT. During the test, in addition to the distance walked, heart rate (HR), blood pressure (BP), and adverse events were also recorded. Electrocardiography was recorded using a Holter monitor in 105 patients. Patients were allocated considering two groups according to the number of days since AMI: Up to 4 Days Group and After 4 Days Group. Results All patients completed the 6MWT, 66 in the Up to 4 Days Group and 86 in the After 4 Days Group. The walking distance was similar in both groups (85% of the predicted value), as well as the physiological responses (increase in systolic BP and HR), reaching 63% (median) of maximum HR. Only 3.9% of patients had major complications (angina, drop in BP, or ventricular tachycardia), with no difference between the groups. None of the complications regarded as severe led to truly significant complications or death. Conclusion The 6MWT was proven to be safe and feasible for early functional evaluation following uncomplicated AMI.

Highlights • Measured and estimated VO2peak in CHF patients showed a moderate association. • With the exception of equation 1, all equations underestimated VO2peak by up to 51%. • The agreement evaluated using Bland–Altman was not consistent., Objectives To evaluate the agreement between the measured peak oxygen uptake (VO2peak) and the VO2peak estimated by four prediction equations based on the six-minute walk test (6MWT) in chronic heart failure patients. Method Thirty-six chronic heart failure patients underwent cardiopulmonary exercise testing and the 6MWT to assess their VO2peak. Four previously published equations that include the variable six-minute walk distance were used to estimate the VO2peak: Cahalin, 1996a (1); Cahalin, 1996b (2); Ross, 2010 (3); and Adedoyin, 2010 (4). The agreement between the VO2peak in the cardiopulmonary exercise testing and the estimated values was assessed using the Bland–Altman method. A p-value of

Background Coronary artery disease (CAD) is among the main causes of hospitalization and death worldwide, therefore, the implementation of programs to reduce its impact is necessary. Supervised cardiac rehabilitation has been shown to have positive effects on CAD control. However, there are barriers to patient participation in the traditional, face-to-face cardiac rehabilitation programs, mainly in low-resource environments. Objective This study aimed to verify patient compliance to a home-based cardiac rehabilitation program, which includes unsupervised health education and physical exercises, guided by telephone. Moreover, we compare this new method to the traditional supervised cardiac rehabilitation offered in most hospital centers. Methods We present here a two-arm, single-blinded, and randomized controlled design protocol, which compares the traditional cardiac rehabilitation (CenterRehab) with the home-based cardiac rehabilitation (Home-Based) in 72 patients affected by CAD. The primary outcome is the compliance to the cardiac rehabilitation sessions. The secondary outcomes (to evaluate effectiveness) include measurable variables such as functional capacity, CAD risk factors (blood pressure, waist circumference, glycemic, cholesterol levels, depressive symptoms, and the level of physical activity), the patient’s quality of life, the disease knowledge, and the morbidity rate. Parameters such as the program cost and the usability will also be evaluated. The programs will last 12 weeks, with a total of 60 rehabilitation and 6 educational sessions. Patients of the CenterRehab program will participate in 24 supervised sessions and 36 home sessions, while the patients of the Home-Based program will participate in 2 supervised sessions and 58 home sessions, guided by telephone. After the 12-week period all participants will be recommended to continue practicing physical exercises at home or at a community center, and they will be invited for re-evaluation after 3 months. The outcomes will be evaluated at baseline, and after 3 and 6 months. Results Participants are currently being recruited for the trial. Data collection is anticipated to be completed by October 2019. Conclusions This is the first study in Brazil comparing the traditional cardiac rehabilitation approach with a novel, home-based protocol that uses an accessible and low-cost technology. If positive results are obtained, the study will contribute to establish a new and viable model of cardiac rehabilitation. Trial Registration ClinicalTrials.gov NCT03605992; https://clinicaltrials.gov/ct2/show/NCT03605992 International Registered Report Identifier (IRRID) DERR1-10.2196/13901

We hypothesize that inspiratory muscle training with conical flow resistance load (IMTFRL-PowerBreath) or respiratory muscle endurance training with normocapnic hyperpnea (RMTNH-SpiroTiger) could offer additional effects in exercise capacity and dyspnea when associated to pulmonary rehabilitation (PR) in COPD patients. Patients with COPD were allocated in 3 groups: PR, PR+IMTFRL, and PR+RMTNH and training during 10-weeks (5/day week - 3 days of full program on Hospital and 2days of aerobic at home). The PR was standard for all group: health education, treadmill aerobic training with 70% of max ISWT speed and peripheral muscle strength training. The PR+IMTFRL group training with a loading of 35% MIP with 5% increase/week up to 80%. The PR+RMTNH group training with a bag equivalent to 50% VC, respiratory rate of 35 times of FEV1, increasing 2 to 3 minutes/week, up to 20 minutes. Outcomes including spirometry, respiratory muscle assessment (MIP, SPImax, SNIP, MEP), 6MWT and ISWT, dyspnea and fatigue were assessed. A total of 33 patients where include, age 66.2±4.9 yrs and BMI 28±4.3 kg/m2. The exercise capacity increased in the PR+IMTFRL and PR+RMTNH (p

Cardiac rehabilitation (CR) is insufficiently available; even less so in low-resource settings. Health care administrators (HAs) are responsible for ensuring CR programs are offered and resourced. This study compared HA CR attitudes in North and South America, the contextual factors associated with these attitudes, and developed a scale/survey to assess them with global applicability.Data were retrospectively analysed from three cross-sectional studies: in (1) 195 HAs from Canada (i.e., North America), (2) 44 HAs from seven South American countries, and (3) 43 HAs from Brazil (all South America). Contextual and perceptual/attitudinal items (five-point Likert scale, with higher scores indicating more positive attitudes) were compared by region. Psychometric properties of items were tested. A literature review was performed, and items generated for content validation by experts.The most negative CR attitudes related to government funding models (mean=2.46±1.14/5), and that patients have responsibility for their disease management (3.03±1.25). North American HAs rated their institutions' perceptions of the importance of CR (p0.001) and quality of the local program (p0.001) higher than their South American counterparts, but rated the utility of CR in lowering length of stay (p0.001), promoting behaviour change (p0.05) and the need for more government funding (p0.05) lower, among others. Total attitude scores were positively associated with CR knowledge/awareness in both cohorts (all p0.01). North American HAs more often perceived CR should be funded by hospitals (p0.001) than South Americans. A 39-item HA CR Attitudes (HACRA-R) scale was developed.Health care administrators' perceptions vary by context, which could impact CR resourcing.