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Purpose. To compare the acute effects of functional electrical stimulation (FES) with 15 and 50 Hertz (Hz) frequencies on muscle strength in patients with heart failure with healthy individuals. Methods. Twenty-two 61.6 ±± 1.0 y-old male volunteers were studied: 10 patients with heart failure (functional class II-III) and 12 healthy controls. The isometric muscle peak torque (IMPT) of the quadriceps femoral muscle was measured through a Biodex dynamometer in maximum voluntary contraction (MVC), and under FES of 50 Hz and 15 Hz, which was applied with a 0.4 ms pulse width, 10-s contraction time, 50- s resting time and maximum tolerable intensity. Results. The IMPT differed in MVC, 50 Hz and 15 Hz FES both in patients (201.9 ±± 14, 55.6 ±± 13 and 42.1 ±± 12 Newton-metre, respectively; p < 0.001) and in controls (179.3 ±± 9, 62.4 ±± 8 and 52.3 ±± 7 Newton-metre, respectively; p < 0.001). There were no differences between the groups. In patients and controls, respectively, the 50 Hz FES corresponded to 27%% versus 35%% and the 15 Hz to 21%% versus 29%% of the IMPT generated at the MVC ( p < 0.001). Discussion. This result can be attributed to the fact that muscle strength is proportional to the stimulation frequency and to the number of recruited motor units. Thus, the higher the frequency, the greater the motor recruiting, producing increased muscle strength. Conclusion. The IMPT generated by acute 50 Hz application of FES is higher than the one generated by 15 Hz, but it is lower than MVC in controls and patients with heart failure. [ABSTRACT FROM AUTHOR]

This study aimed to review the prevalence of developmental coordination disorder (DCD) in individuals born preterm and systematically explore this prevalence according to gestational age and different assessment cut-offs and compare it to full-term peers. The eligibility criteria were observational and experimental studies reporting the prevalence of DCD in preterm individuals. A systematic search was performed in databases from inception until March 2022. Two independent reviewers performed the selection. Study quality assessment was performed using the checklists from Joanna Briggs Institute (JBI). Data analysis was performed on Excel and Review Manager Software 5.4. Among the 1774 studies identified, 32 matched the eligibility criteria. The pooled estimate rate of the DCD rate in preterm was 21% (95% confidence interval [CI] 17.8-24.3). The estimate rates were higher as gestational age decreased, and preterm children are two times more likely to have DCD than their full-term peers risk ratio (RR) 2.2 (95% CI 1.77-2.79). The limitation was high heterogeneity between studies; the assessment tools, cut-off points and age at assessment were diverse. This study provided evidence that preterm children are at higher risk for DCD than full-term children, and the risks increased as gestational age decreased., (© 2024 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.)

Objective: To identify the influence of obesity on mortality, time to weaning from mechanical ventilation and mobility at intensive care unit discharge in patients with COVID-19., Methods: This retrospective cohort study was carried out between March and August 2020. All adult patients admitted to the intensive care unit in need of ventilatory support and confirmed to have COVID-19 were included. The outcomes included mortality, time on mechanical ventilation, and mobility at intensive care unit discharge., Results: Four hundred and twenty-nine patients were included, 36.6% of whom were overweight and 43.8% of whom were obese. Compared with normal body mass index patients, overweight and obese patients had lower mortality (p = 0.002) and longer intensive care unit survival (log-rank p < 0.001). Compared with patients with a normal body mass index, overweight patients had a 36% lower risk of death (p = 0.04), while patients with obesity presented a 23% lower risk (p < 0.001). There was no association between obesity and time on mechanical ventilation. The level of mobility at intensive care unit discharge did not differ between groups and showed a moderate inverse correlation with length of stay in the intensive care unit (r = -0.461; p < 0.001)., Conclusion: Overweight and obese patients had lower mortality and higher intensive care unit survival rates. The duration of mechanical ventilation and mobility level at intensive care unit discharge did not differ between the groups.

Objective: The objective of this study was to evaluate the impact of intensive care unit (ICU)-acquired weakness (ICUAW) on the functional independence of patients hospitalized for coronavirus disease 2019 (COVID-19) over 6 months after ICU discharge., Methods: This was a prospective cohort study that included patients who were admitted to the ICU because of COVID-19 and who were monitored for 6 months after discharge from the ICU via telephone. Patients were evaluated at 3 times (30 days, 3 months, and 6 months after discharge from the ICU) for functional independence for personal care and mobility activities (Barthel Scale), independence for self-care (Katz Index), impact of COVID-19 on functional status (post-COVID-19 Functional Status Scale [PCFS]), and mobility level (ICU Mobility Scale). The existence of some degree of dependence was considered when the Barthel Scale score was <100 points, the Katz Index was ≥1, and the PCFS score was ≥1. A PCFS score of ≥3 indicated moderate or severe dependence. Patients with a Medical Research Council score of <48 at discharge from the ICU were diagnosed with ICUAW., Results: Sixty-eight patients were included, with a mean age of 51 (SD = 13) years. The ICUAW rate at ICU discharge was 35%. In the evaluation with the PCFS, the values for the presence of any functional limitation at 30 days, 3 months, and 6 months after ICU discharge were 89.7%, 57.4%, and 38.2%, respectively. The rate of persistence of functional limitations after 6 months was higher in patients with ICUAW than in those without ICUAW (66.7% vs 22.8%; P = .000); the same was true for moderate or severe limitations (20.8% vs 4.5%; P = .035). Likewise, functional independence for personal care, mobility, and self-care activities was poorer in patients with ICUAW., Conclusions: In patients surviving an ICU stay due to COVID-19, decreased functional independence persists even 6 months after discharge, and patients with ICUAW have worse outcomes., Impact: Patients who survive ICU stays due to COVID-19 continue to have greater functional dependence even 6 months after ICU discharge., (© The Author(s) 2023. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Airway management is challenging in trauma patients because of the fear of worsening cervical spinal cord damage. Video-integrated and optic-integrated devices and intubation laryngeal mask airways have been proposed as alternatives to direct laryngoscopy with the Macintosh laryngoscope (MAC). We performed a meta-analysis to clarify which devices cause less cervical movement during airway management., Methods: We searched MEDLINE, Cochrane Central, Embase and LILACS from inception to January 2022. We selected randomised controlled trials comparing alternative devices with the MAC for cervical movement from C0 to C5 in adult patients, evaluated by radiological examination. Additionally, cervical spine immobilisation (CSI) techniques were evaluated. We used the Cochrane Risk of Bias Tool to evaluate the risk of bias, and the principles of the Grading of Recommendations, Assessment, Development, and Evaluations system to assess the quality of the body of evidence., Results: Twenty-one studies (530 patients) were included. Alternative devices caused statistically significantly less cervical movement than MAC during laryngoscopy with mean differences of -3.43 (95% CI -4.93 to -1.92) at C0-C1, -3.19 (-4.04 to -2.35) at C1-C2, -1.35 (-2.19 to -0.51) at C2-C3, and -2.61 (-3.62 to -1.60) at C3-C4; and during intubation: -3.60 (-5.08 to -2.12) at C0-C1, -2.38 (-3.17 to -1.58) at C1-C2, -1.20 (-2.09 to -0.31) at C2-C3. The Airtraq and the Intubation Laryngeal Mask Airway caused statistically significant less movement than MAC restricted to some cervical segments, as well as CSI. Heterogeneity was low to moderate in most results. The quality of the body of evidence was 'low' and 'very low'., Conclusions: Compared with the MAC, alternative devices caused less movement during laryngoscopy (C0-C4) and intubation (C0-C3). Due to the high risk of bias and the very low grade of evidence of the studies, further research is necessary to clarify the benefit of each device and to determine the efficacy of cervical immobilisation during airway management., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: The primary objective of this study was to identify the occurrence and factors associated with intensive care unit (ICU)-acquired weakness (ICUAW) in patients with COVID-19. Secondarily, we monitored the evolution of muscle strength and mobility among individuals with ICUAW and those without ICUAW and the association of these variables with length of stay, mechanical ventilation (MV), and other clinical variables., Methods: In this prospective observational study, individuals admitted to the ICU for >72 hours with COVID-19 were evaluated for muscle strength and mobility at 3 times: when being weaned from ventilatory support, discharged from the ICU, and discharged from the hospital. Risk factors for ICUAW were monitored., Results: The occurrences of ICUAW at the 3 times evaluated among the 75 patients included were 52%, 38%, and 13%. The length of the ICU stay (29.5 [IQR = 16.3-42.5] vs 11 [IQR = 6.5-16] days), the length of the hospital stay (43.5 [IQR = 22.8-55.3] vs 16 [IQR = 12.5-24] days), and time on MV (25.5 [IQR = 13.8-41.3] vs 10 [IQR = 5-22.5] days) were greater in patients with ICUAW. Muscle strength and mobility were lower at all times assessed in patients with ICUAW. Bed rest time for all patients (relative risk = 1.14; 95% CI = 1.02 to 1.28) and use of corticosteroids (relative risk = 1.01; 95% CI = 1.00 to 1.03) for those who required MV were factors independently associated with ICUAW. Muscle strength was found to have a positive correlation with mobility and a negative correlation with lengths of stay in the ICU and hospital and time on MV., Conclusion: The occurrence of ICUAW was high on patients' awakening in the ICU but decreased throughout hospitalization; however, strength and mobility remained compromised at hospital discharge. Bed rest time and use of corticosteroids (for those who needed MV) were factors independently associated with ICUAW in patients with COVID-19., Impact: Patients who had COVID-19 and developed ICUAW had longer periods of ICU stay, hospital stay, and MV. Bed rest time and use of corticosteroids (for those who required MV) were factors independently associated with ICUAW., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Metabolites produced during muscle exercise can sensitize types III and IV fibers, which account for increasing blood pressure (BP) and vascular resistance in non-exercising limbs, as well as for redistributing the blood flow to active muscles; reflex response is called metaboreflex. Neuromuscular electrical stimulation (NMES) induces greater local muscle metabolic demand than voluntary isometric contractions. Metabolic accumulation is essential to activate muscle metaboreflex; thus, the hypothesis of the current study is that one NMES session can induce metaboreflex with different hemodynamic responses in upper and lower limbs. Objective - to investigate whether one acute NMES session could activate metaboreflex by inducing different hemodynamic responses between arms and legs., Methods: Twenty (20) healthy subjects (mean age = 47.7±9.4 years, 13 women, mean body mass index = 26 ± 3 kg/m 2 ) participated in this randomized crossover study. All participants were subjected to two NMES interventions, one in the upper limbs (UPL) and the other in the lower limbs (LL). Mean blood pressure (MBP), blood flow (BF) and vascular resistance (VR) were used to selectively evaluate metaboreflex responses at baseline, during NMES interventions, and recovery periods with, and without, postexercise circulatory occlusion (PECO+ and PECO-, respectively) through the area under the curve (AUC) in VR., Results: MBP increased by 13% during UPL interventions and only remained high during PECO+. Changes in MBP were not observed in LL, although BF in the contralateral leg has decreased by 14% during PECO+ protocol. Muscle metaboreflex activation (AUC differences in VR between PECO+ and PECO-) was not different between UPL and LL (P=0.655)., Conclusions: Acute NMES session has induced similar metaboreflex activation in both arms and legs, although hemodynamic responses differed between interventions.

Purpose: Neuromuscular electrical stimulation (NMES) is a widely-used technique for diagnostic and therapeutic purposes. Here we developed and tested the reliability of a new NMES-dynamometer system for bedside evaluation of knee extensor muscle function., Materials and Methods: Thirty-two healthy participants (16 men, 16 women; 27±5 years) completed two testing sessions, 7 days apart. On day 1, a single experienced rater, who repeated the evaluation on day 2 with two other raters, completed a standardized testing procedure. Participants were placed supine, with knees flexed and legs connected to the dynamometer. Maximal voluntary knee extensor isometric force (MVF) and supramaximal twitch force (TwF) were obtained., Results: High intra-rater intraclass correlation coefficients were observed for both MVF (0.91) and TwF (0.94). MVF and TwF standard error of measurements (8.2%, 5.9%) and minimal detectable changes (16%, 11.6%) were low compared to mean values. High intraclass correlation coefficients were also observed for inter-rater comparisons of MVF (0.89) and TwF (0.86). Standard errors of measurements (MVF: 8.7%, TwF: 5.5%) and minimal detectable changes (MVF: 17.2%, TwF: 10.8%) were similar to intra-rater comparisons., Conclusion: The good reliability of the novel NMES-dynamometer system suggests it as an appropriate tool for the bedside evaluation of knee extensor muscle function., (Copyright © 2021 IPEM. Published by Elsevier Ltd. All rights reserved.)

Introduction: The aim of this study was to evaluate the intra and inter-rater and inter-analyzer reliability of neuromuscular variables and functional tests., Methods: Cross-sectional crossover design. Two independent raters and analyzers evaluated twenty-two healthy subjects. Knee-extensor strength was assessed from three maximal voluntary isometric contractions. Muscle activation was obtained from the vastus lateralis (VL), rectus femoris (RF), and vastus medialis (VM) muscles. VL and RF muscles' architecture [fascicle length (FL), pennation angle (PA), muscle thickness (MT)] was obtained at rest by ultrasound. The time from five sit-to-stand (STS) trials, and the distance from the 6-min walk test (6MWT) were obtained. Intraclass correlation coefficient was determined and classified as strong (r = 0.75-1.00), moderate (r = 0.40-0.74), and weak (r < 0.40)., Results: Strong intra-rater reliability values were observed for strength (r = 0.97), muscle activation [VL (r = 0.91); RF (r = 0.92); VM (r = 0.80)], VL [FL (r = 0.90); PA (r = 0.94); MT (r = 0.99)] and RF [MT (r = 0.85)] muscle architecture, STS (r = 0.95), and 6MWT (r = 0.98). Inter-rater reliability also presented strong values for strength (r = 0.97), muscle activation [VL (r = 0.94); RF (r = 0.79); VM (r = 0.78)], muscle architecture VL [PA (r = 0.81) and MT (r = 0.88)] and RF [MT (r = 0.80)], STS (r = 0.93), and 6MWT (r = 0.98). A moderate correlation VL muscle architecture [FL (r = 0.69)]. Inter-analyzer muscle architecture reliability presented strong VL [FL (r = 0.77); PA (r = 0.76); MT (r = 0.91)] and RF [MT (r = 0.99)]., Conclusion: The high intra and inter-rater and inter-analyzer reliability values for most variables is evidence that they can be used for clinical evaluation. Muscle architecture might need a longer training period by different raters and analyzers to increase reliability., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: To evaluate effectiveness of positive expiratory pressure blow-bottle device compared to expiratory positive airway pressure and conventional physiotherapy on pulmonary function in postoperative cardiac surgery patients in intensive care unit., Design: A randomized controlled trial., Settings: Tertiary care., Subjects: 48 patients (16 in each group; aged 64.5 ± 9.1 years, 38 male) submitted to cardiac surgery., Interventions: Patients were randomized into conventional physiotherapy (G1), positive expiratory pressure blow-bottle device (G2) or expiratory positive airway pressure, both associated with conventional physiotherapy (G3). G2 and G3 performed three sets of 10 repetitions in each session for each technique., Main Measures: Pulmonary function (primary); respiratory muscle strength, radiological changes, pulmonary complications, length of intensive care unit and hospital stay (secondary) assessed preoperatively and on the 3rd postoperative day., Results: Pulmonary function (except for forced expiratory volume in one second/ forced vital capacity % predicted) and respiratory muscle strength showed significant reduction from the preoperative to the 3rd postoperative in all groups ( P  < 0.001), with no difference between groups ( P  > 0.05). Regarding radiological changes, length of intensive care unit stay and length of hospital stay, there was no significant difference between groups ( P  > 0.05)., Conclusion: Both positive expiratory pressure techniques associated with conventional physiotherapy were similar, but there was no difference regarding the use of positive expiratory pressure compared to conventional physiotherapy., Clinical Trial Registration Number: NCT03639974.https://clinicaltrials.gov/ct2/show/NCT03639974.

Objective: The benefits of inspiratory muscle training (IMT) have already been demonstrated in patients with heart failure (HF), but the best mode of training and which patients benefit from this intervention are not clear. The purpose of this study was to review the effects of IMT on respiratory muscle strength, functional capacity, pulmonary function, quality of life, and dyspnea in patients with HF; IMT isolated or combined with another intervention (combined IMT), the presence of inspiratory muscle weakness, training load, and intervention time were considered., Methods: The search included the databases MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, and LILACS database through September 2019. The review included randomized studies that assessed IMT in isolation or combined with another intervention-in comparison with a control group, a placebo, or another intervention-in patients with HF. Fourteen studies were included, 13 for meta-analysis (10 for isolated IMT and 3 for combined IMT)., Results: Isolated IMT demonstrated an increase in maximal inspiratory pressure (MIP) (25.12 cm H2O; 95% CI = 15.29 - 34.95), 6-Minute Walk Test (81.18 m; 95% CI = 9.73 - 152.63), maximum oxygen consumption (12 weeks: 3.75 mL/kg/min; 95% CI = 2.98 to 4.51), and quality of life (-20.68; 95% CI = -29.03 to -12.32). The presence of inspiratory muscle weakness, higher loads, and longer intervention times resulted in greater increases in MIP. IMT combined with another intervention demonstrated an increase only in MIP., Conclusions: Isolated IMT resulted in an increase in inspiratory muscle strength, functional capacity, and quality of life. IMT combined with another intervention resulted only in a small increase in inspiratory strength. Isolated IMT with higher loads can be considered an adjuvant intervention, especially for those who do not adhere to conventional rehabilitation and who have respiratory muscle weakness., Impact: A systematic review was necessary to review the effects of IMT on respiratory muscle strength, lung function, functional capacity, quality of life, and dyspnea in patients with HF. Various clinical issues important for a better training prescription were considered; these included whether the performance of the training IMT as a form of isolated training benefits patients with HF, whether the combination of IMT with another intervention has additional effects, whether any patient with HF can benefit from IMT (alone or combined with another intervention), and whether only patients who already have respiratory muscle weakness benefit. Also important was establishing which training load provides the best result and the best intervention time, so that health care can be provided more efficiently., Lay Summary: For people with heart failure, IMT by itself, without being combined with other exercise, can improve ease of breathing, increase the amount of distance that they can walk, and improve quality of life. Inspiratory training with higher loads might be helpful for those with respiratory muscle weakness who are unable to do conventional exercise., (© The Author(s) 2020. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Expiratory positive airway pressure (EPAP) is widely applicable, either as a strategy for pulmonary reexpansion, elimination of pulmonary secretion or to reduce hyperinflation. However, there is no consensus in the literature about the real benefits of EPAP in reducing dynamic hyperinflation (DH) and increasing exercise tolerance in subjects with chronic obstructive pulmonary disease (COPD). To systematically review the effects of EPAP application during the submaximal stress test on DH and exercise capacity in patients with COPD. This meta-analysis was performed from a systematic search in the PubMed, EMBASE, PeDRO, and Cochrane databases, as well as a manual search. Studies that evaluated the effect of positive expiratory pressure on DH, exercise capacity, sensation of dyspnea, respiratory rate, peripheral oxygen saturation, sense of effort in lower limbs, and heart rate were included. GRADE was used to determine the quality of evidence for each outcome. Of the 2,227 localized studies, seven studies were included. The results show that EPAP did not change DH and reduced exercise tolerance in the constant load test. EPAP caused a reduction in respiratory rate after exercise (- 2.33 bpm; 95% CI: - 4.56 to - 0.10) (very low evidence) when using a pressure level of 5 cmH 2 O. The other outcomes analyzed were not significantly altered by the use of EPAP. Our study demonstrates that the use of EPAP does not prevent the onset of DH and may reduce lower limb exercise capacity in patients with COPD. However, larger and higher-quality studies are needed to clarify the potential benefit of EPAP in this population.

Background: The benefits of inspiratory muscle training (IMT) for patients with COPD are documented in the literature, but its isolated effect or association with other interventions, the best training methods, and what type of patient benefits the most are not clear. We sought to assess the effects of IMT on respiratory muscle strength, pulmonary function, dyspnea, functional capacity, and quality of life for subjects with COPD, considering IMT isolated or association with other interventions, presence of inspiratory muscle weakness, training load, and intervention time., Methods: We searched the MEDLINE, EMBASE, PEDro, Cochrane CENTRAL, and LILACS databases in June 2018. We also performed a manual search of references in the studies found in the database search and included in this analysis. We included randomized controlled trials that investigated the above-mentioned outcomes and assessed IMT, either isolated or associated with other interventions, in comparison with a control group, placebo, or other interventions, in subjects with COPD. We used the GRADE approach to evaluate the quality of the evidence., Results: Of 1,230 search results, 48 were included ( N = 1,996 subjects). Isolated IMT increased P Imax (10.64 cm H 2 O, 95% CI 7.61-13.66), distance walked in 6-min-walk test (34.28 m; 95% CI 29.43-39.14), and FEV 1 (0.08, 95% CI 0.02-0.13). However, there was no improvement in dyspnea and quality of life. The presence of inspiratory muscle weakness did not change the results; higher loads (60-80% of P Imax ) promoted a greater improvement in these outcomes, and a shorter intervention time (4 weeks) improved P Imax , but longer intervention times (6-8 weeks) are required to improve functional capacity. IMT associated with other interventions only showed an increase in P Imax (8.44 cm H 2 O; 95% CI 4.98-11.91), and the presence of inspiratory muscle weakness did not change this result., Conclusions: Isolated IMT improved inspiratory muscle strength, functional capacity, and pulmonary function, without changing dyspnea and quality of life. Associated IMT only increased inspiratory muscle strength. These results indicate that isolated IMT can be considered as an adjuvant intervention in patients with COPD., Competing Interests: This study was supported by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior. The authors have disclosed no conflicts of interest., (Copyright © 2020 by Daedalus Enterprises.)

Purpose: To evaluate the effects of transcutaneous electrical nerve stimulation (TENS) compared to placebo TENS and a control group on pain, pulmonary function, respiratory muscle strength, and analgesic medications in the postoperative period of thoracotomy in an Intensive care unit (ICU)., Methods: Patients who had undergone posterolateral thoracotomy were randomly allocated to receive TENS during ICU stay, or placebo TENS, or into the control group. All groups received conventional physiotherapy. We analysed the intensity of pain, pulmonary function, respiratory muscle strength, and use of analgesia medications. Outcomes were evaluated before surgery, immediately after, 24 and 48 h after ICU admission., Results: Forty-five patients were included. Regarding pain perception, there was no difference between groups (p = 0.172), but there was a significant reduction in pain intensity for patients receiving TENS after first physiotherapy session compared to baseline (4.7 ± 3.2 vs 3.3 ± 2.6; p < 0.05). All groups had a decrease in forced vital capacity (FVC) after surgery (p < 0.001). There was no difference between the groups regarding the use of analgesic medications, but a higher intake of morphine and acetaminophen were observed for the control (p = 0.037) and placebo group (p = 0.035), respectively., Conclusion: The use of TENS provides a little benefit of pain (in the first 12 h) but failed to demonstrate any improvement in the recovery of ICU patients after 48 h of posterolateral thoracotomy., Trial Registration: NCT02438241.

Introduction: The ultrasound technique has been extensively used to measure echo intensity, with the goal of measuring muscle quality, muscle damage, or to detect neuromuscular disorders. However, it is not clear how reliable the technique is when comparing different days, raters, and analysts, or if the reliability is affected by the muscle site where the image is obtained from. The goal of this study was to compare the intra-rater, inter-rater, and inter-analyst reliability of ultrasound measurements obtained from two different sites at the rectus femoris muscle., Methods: Muscle echo intensity was quantified from ultrasound images acquired at 50% [RF 50 ] and at 70% [RF 70 ] of the thigh length in 32 healthy subjects., Results: Echo intensity values were higher ( p  = 0.0001) at RF 50 (61.08 ± 12.04) compared to RF 70 (57.32 ± 12.58). Reliability was high in both RF 50 and RF 70 for all comparisons: intra-rater (ICC = 0.89 and 0.94), inter-rater (ICC = 0.89 and 0.89), and inter-analyst (ICC = 0.98 and 0.99), respectively. However, there were differences ( p  < 0.05) between raters and analysts when obtaining/analyzing echo intensity values in both rectus femoris sites., Conclusions: The differences in echo intensity values between positions suggest that rectus femoris's structure is not homogeneous, and therefore measurements from different muscle regions should not be used interchangeably. Both sites showed a high reliability, meaning that the measure is accurate if performed by the same experienced rater in different days, if performed by different experienced raters in the same day, and if analyzed by different well-trained analysts, regardless of the evaluated muscle site., (© The British Medical Ultrasound Society 2019.)

Objective: To evaluate the effects of high-intensity interval training (HIIT), in comparison with those of continuous exercise, on functional capacity and cardiovascular variables in patients with COPD, through a systematic review and meta-analysis of randomized controlled trials., Methods: We searched PubMed, the Physiotherapy Evidence Database, the Cochrane Central Register of Controlled Trials, and EMBASE, as well as performing hand searches, for articles published up through January of 2017. We included studies comparing exercise regimens of different intensities, in terms of their effects on functional capacity and cardiovascular variables in patients with COPD., Results: Of the 78 articles identified, 6 were included in the systematic review and meta-analysis. Maximal oxygen consumption (VO2max) did not differ significantly between HIIT and control interventions. That was true for relative VO2max (0.03 mL/kg/min; 95% CI: -3.05 to 3.10) and absolute VO2max (0.03 L/min, 95% CI: -0.02 to 0.08)., Conclusions: The effects of HIIT appear to be comparable to those of continuous exercise in relation to functional and cardiovascular responses. However, our findings should be interpreted with caution because the studies evaluated present a high risk of bias, which could have a direct influence on the results.

Objective: To systematically review the effects of bilevel ventilatory support (BVS) in patients with Obesity Hypoventilation Syndrome (OHS)., Methods: A search of databases (MEDLINE accessed by PubMed, Cochrane CENTRAL, EMBASE and LILACS) was conducted from inception to June 2018. Randomized trials comparing BVS to other therapeutic modalities such as lifestyle counseling, continuous positive airway pressure (PAP) or BVS with average volume assured pressure support for the treatment of patients with OHS were included. The primary outcome was a change in daytime arterial carbon dioxide levels (PaCO 2 ). Secondary outcome measures included arterial partial pressure of oxygen (PaO 2 ), blood bicarbonate (HCO 3 ), percentage of total sleep time (TST) with oxygen saturation <90%, transcutaneous pressure of carbon dioxide (PtcCO 2 ), Epworth Sleepiness Scale (ESS), Medical Outcome Survey Short Form (SF36), Functional Outcomes of Sleep Questionnaire (FOSQ), Severe Respiratory Insufficiency Questionnaire (SRI), compliance with treatment, and weight loss., Results: Of 176 articles identified, seven studies were included. When BVS was compared to lifestyle counseling, the intervention was superior in improving PaCO 2 (-2.90 mmHg; 95%CI -4.28 to -1.52), PaO 2 (2.89 mmHg; 95%CI 0.33 to 5.46), HCO 3 (-2.55 mmol/L; 95%CI -3.28 to -1.81), percentage of TST<90% (-30.55%; 95%CI -37.98 to -23.12), ESS (-2.52; 95%CI -4.16 to -0.88) and FOSQ (6.33; 95%CI 1.78 to 10.88). However, when BVS was compared to other PAP modalities, there was no difference in any of the outcomes evaluated., Conclusions: Treatment using BVS therapy is superior to lifestyle counseling. Different PAP modalities appear to be equally effective in improving outcomes. CRD42017065326., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Questions: Do aerobic, resistance and combined exercise training improve aerobic capacity, arterial blood pressure and haemodialysis efficiency in people requiring haemodialysis for end-stage renal disease? Is one exercise training modality better than the others for improving these outcomes?, Design: Systematic review with network meta-analysis of randomised trials., Participants: Adults requiring haemodialysis for end-stage renal disease., Intervention: Aerobic training, resistance training, combined training and control (no exercise or placebo)., Outcome Measures: Aerobic capacity, arterial blood pressure at rest, and haemodialysis efficiency., Results: Thirty-three trials involving 1254 participants were included. Direct meta-analyses were conducted first. Aerobic capacity improved significantly more with aerobic training (3.35 ml/kg/min, 95% CI 1.79 to 4.91) and combined training (5.00 ml/kg/min, 95% CI 3.50 to 6.50) than with control. Only combined training significantly reduced systolic (-9 mmHg, 95% CI -13 to -4) and diastolic (-5 mmHg, 95% CI -6 to -3) blood pressure compared to control. Only aerobic training was superior to control for haemodialysis efficiency (Kt/V 0.11, 95% CI 0.02 to 0.20). However, when network meta-analysis was conducted, there were some important different findings. Both aerobic training and combined training again elicited greater improvements in aerobic capacity than control. For systolic blood pressure, combined training was superior to control. For diastolic blood pressure, combined training was superior to aerobic training and control. No modality was superior to control for haemodialysis efficiency. Combined training was ranked as the most effective treatment for aerobic capacity and arterial blood pressure., Conclusion: Combined training was the most effective modality to increase aerobic capacity and blood pressure control in people who require haemodialysis. This finding helps to fill the gap created by the lack of head-to-head comparisons of different modalities of exercise in people with end-stage renal disease., Registration: PROSPERO CRD42015020531., (Copyright © 2018 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.)

Urinary incontinence (UI) is any involuntary loss of urine. In female athletes, physical exercise may be a risk factor for UI because of increased intra-abdominal pressure generated during high-impact exercises, which overloads the pelvic organs, predisposing them to UI. This is a systematic review of the prevalence of UI in female athletes in different sports. A search for articles was carried out in the PEDro, Scopus, Cinahl, PubMed, LILACS, SciELO, Science Direct, Web of Science, Embase, and Cochrane databases as well as a manual search of the references of studies already published on the subject with the keywords "athlete," "urinary incontinence," and "women" in Portuguese and English. Only articles published from 2000 to 2016 were included. Observational studies assessing the prevalence of UI in female athletes were selected. Methodological quality was assessed using the Downs and Black scale, and the data collected from the studies were analyzed through meta-analysis. Eight studies met the eligibility criteria. Meta-analysis showed a 36% prevalence of UI in female athletes in different sports, and compared with sedentary women, the athletes had a 177% higher risk of presenting with UI. There is a higher prevalence of UI in female athletes compared with sedentary women. There have been reports of UI in different sports.

Objective:: To investigate how dynamic neuromuscular control, postural sway, joint position sense, and incidence of ankle sprain are influenced by balance training in athletes compared with the control group in randomized clinical trials., Data Sources:: The search strategy included MEDLINE, Physical Therapy Evidence Database, Cochrane Central Register of Controlled Trials, and Latin American and Caribbean Center on Health Sciences Information. Randomized controlled trials (RCTs) were published by June of 2018., Methods:: RCTs that evaluate the effectiveness of proprioception in these outcomes: dynamic neuromuscular control, postural sway, joint position, and the incidence of ankle sprains in athletes aged between 18 and 35 years. Two reviewers independently screened the searched records, extracted the data, and assessed risk of bias. The treatment effect sizes were pooled in a meta-analysis using the RevMan 5.2 software. Internal validity was assessed through topics suggested by Cochrane Collaborations., Results:: Of the 12 articles included ( n = 1817), eight were in the meta-analysis ( n = 1722). The balance training reduced the incidence of ankle sprains in 38% compared with the control group ( RR: 0.62; 95% CI: 0.43-0.90). In relation to the dynamic neuromuscular control, the training showed increase in the distance of reach in the anterior (0.62 cm, 95% CI: 0.13-1.11), posterolateral (4.22 cm, 95% CI: 1.76-6.68), and posteromedial (3.65 cm, 95% CI: 1.03-6.26) through the Star Excursion Balance test. Furthermore, training seems to improve postural sway and joint position sense., Conclusion:: Balance training reduces the incidence of ankle sprains and increases dynamic neuromuscular control, postural sway, and the joint position sense in athletes.

In this meta-analysis, we investigated the effect of resistance training (RT) alone or included in a multimodal training on physical frailty outcomes, and whether different variables of RT prescription affect these outcomes. We identified 15 relevant studies searching through MEDLINE, Cochrane Central Register of Controlled Trials, SPORTDiscus, and PEDro database. Postintervention standardized mean difference scores were computed and combined using fixed effects meta-analysis. Analyses have shown positive effects of interventions on maximum strength, gait speed, and Timed Up and Go test. Further analyses have shown significant greater effect of shorter periods on maximum strength. Regarding RT prescription, percentage of one-repetition maximum showed significant effect on physical variables, whereas RT based on rate of perceived effort presented lower effect in the Timed Up and Go test. Although multimodal training is an effective intervention to increase physical capacity, caution should be taken regarding the period and the method to control RT intensity to optimize enhancements in frail older people.

Objective: To review the evidence on the safety of neuromuscular electrical stimulation when used in the intensive care unit., Methods: A systematic review was conducted; a literature search was performed of the MEDLINE (via PubMed), PEDro, Cochrane CENTRAL and EMBASE databases, and a further manual search was performed among the references cited in randomized studies. Randomized clinical trials that compared neuromuscular electrical stimulation to a control or placebo group in the intensive care unit and reporting on the technique safety in the outcomes were included. Hemodynamic variables and information on adverse effects were considered safety parameters. Articles were independently analyzed by two reviewers, and the data analysis was descriptive., Results: The initial search located 1,533 articles, from which only four randomized clinical trials were included. Two studies assessed safety based on hemodynamic variables, and only one study reported an increase in heart rate, respiratory rate and blood lactate, without clinical relevance. The other two studies assessed safety based on reported adverse effects. In one, 15% of patients described a prickling sensation, without any clinically relevant abnormalities. In the other, one patient suffered a superficial burn due to improper parameter configuration., Conclusion: Neuromuscular electrical stimulation is safe for critically ill patients; however, it should be applied by duly trained professionals and with proper evidence-based parameters.

Background: Blood pressure (BP) variability can be evaluated by 24-hour ambulatory BP monitoring (24h-ABPM), but its concordance with results from finger BP measurement (FBPM) has not been established yet., Objective: The aim of this study was to compare parameters of short-term (24h-ABPM) with very short-term BP variability (FBPM) in healthy (C) and diabetic-hypertensive (DH) subjects., Methods: Cross-sectional study with 51 DH subjects and 12 C subjects who underwent 24h-ABPM [extracting time-rate, standard deviation (SD), coefficient of variation (CV)] and short-term beat-to-beat recording at rest and after standing-up maneuvers [FBPM, extracting BP and heart rate (HR) variability parameters in the frequency domain, autoregressive spectral analysis]. Spearman correlation coefficient was used to correlate BP and HR variability parameters obtained from both FBPM and 24h-ABPM (divided into daytime, nighttime, and total). Statistical significance was set at p < 0.05., Results: There was a circadian variation of BP levels in C and DH groups; systolic BP and time-rate were higher in DH subjects in all periods evaluated. In C subjects, high positive correlations were shown between time-rate index (24h-ABPM) and LF component of short-term variability (FBPM, total, R = 0.591, p = 0.043); standard deviation (24h-ABPM) with LF component BPV (FBPM, total, R = 0.608, p = 0.036), coefficient of variation (24h-ABPM) with total BPV (FBPM, daytime, -0.585, p = 0.046) and alpha index (FBPM, daytime, -0.592, p = 0.043), time rate (24h-ABPM) and delta LF/HF (FBPM, total, R = 0.636, p = 0.026; daytime R = 0,857, p < 0.001). Records obtained from DH showed weak positive correlations., Conclusions: Indices obtained from 24h-ABPM (total, daytime) reflect BP and HR variability evaluated by FBPM in healthy individuals. This does not apply for DH subjects.

This study aimed to evaluate the effects of neuromuscular electrical stimulation (NMES) on muscle strength and architecture, functional capacity, and endothelial function in patients with chronic kidney failure (CKF) on hemodialysis (HD). Twenty-one patients with CKF on HD were randomized into a control group (CG; n = 10) and neuromuscular electrical stimulation group (NMESG; n = 11) who received NMES in the quadriceps muscle for 8 weeks, 3 times/week (20-34 min) during HD sessions. The muscle strength of the lower limbs was evaluated by dynamometry and sit-and-stand test (SST); muscle architecture through ultrasonography; functional capacity by the distance covered in a 6-min walk test and the endothelial function by flow-mediated dilatation technique of the brachial artery. There was an increase in the strength of the lower limbs in the NMESG compared to the CG (dynamometry: 43.28 ± 16.94 vs. 35.84 ± 16.89, P = 0.006; SST: 16.10 ± 6.51 vs. 12.50 ± 4.7, P = 0.029). There was a significant reduction in pennation angles of the right vastus lateralis (RVL) and left vastus lateralis (LVL) in the CG when compared to the NMESG (RVL: 11.93 [10.70-15.11] vs. 13.57 [11.81-15.96], P = 0.039; LVL: 11.62 [9.00-14.20] vs. 15.52 [12.86-20.02], P = 0.042). There was no change in functional capacity and in the endothelial function for CG and NMESG, respectively. In conclusion, NMES increases muscle strength and has a protective effect against muscle atrophy of the lower limbs of patients with chronic kidney failure on HD., (© 2017 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.)

Background: Children and adolescents with congenital heart disease often have alterations in their exercise capacity that can be evaluated by various functional testing., Objective: To evaluate the functional capacity of children and adolescents with congenital heart disease (CHD) with systematic review and meta-analyses., Methods: The review included observational studies, data from the first evaluation of randomized clinical trials or observational follow-up periods after clinical trials which evaluated functional capacity by cardiopulmonary exercise test, stress testing, six-minute walk test or step test, in children and adolescents with CHD, aged between six and 18 years, and comparisons with healthy controls in the same age group. The quantitative assessment was performed by meta-analysis, by comparing the maximal oxygen consumption (VO2max) of children and adolescents with CHD and respective control groups., Results: Twenty-five of 2.683 studies identified in the search met the inclusion criteria. The VO2max measurement showed that patients with CHD have a decrease of 9.31 ml/Kg/min (95% CI. -12.48 to -6.13; I2, 94.3%, P for heterogeneity < 0.001) compared with the control group. The meta-analysis of the data of maximum heart rate (HR) reached during cardiopulmonary test and stress testing, retrieved from 18 studies, showed a HR value of -15.14 bpm (95% CI. -20.97 to -9.31; I2, 94.3%, P for heterogeneity < 0.001) compared with the control group., Conclusion: Children and adolescents with CHD have lower VO2max and HR compared to controls.

Background: Monochromatic infrared energy (MIRE) or phototherapy has been used to improve plantar sensitivity and pain in lower limbs of patients with diabetic sensorimotor peripheral neuropathy (DSPN), but the available primary results are inconsistent., Objective: To review systematically the effects of MIRE on plantar sensitivity and neuropathic pain in patients with DSPN., Methods: Medline, EMBASE, Cochrane CENTRAL, and Google Scholar were searched up to September 2016. Randomized controlled trials addressing the effects of MIRE on plantar sensitivity and neuropathic pain in patients with DSPN were selected. Study inclusion, risk of bias and quality assessment, and data extraction were completed by two independent reviewers., Results: Of 2549 records identified, six studies met the selection criteria, with 304 patients (594 feet) randomized. MIRE was not associated with improvement in plantar tactile sensitivity (SMD=0.22, 95%CI -0.07 to 0.51, low quality of evidence). Subgroups of studies with short-term (up to 2 weeks) follow-up showed significant improvement in plantar sensitivity (SMD=0.41, 95% CI 0.18-0.64). Neuropathic pain increased significantly in patients who received MIRE (MD=0.49, 95% CI 0.30-0.68, low quality of evidence)., Conclusions: There was limited evidence that MIRE results in short-term improvement of tactile sensitivity probably not sustained over time. Limited evidence also suggested that MIRE does not provide relief for neuropathic pain. As quality of evidence is low, further studies are likely to change the estimated effect., (Copyright © 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Background: Functional electrical stimulation (FES) has shown benefits in patients with chronic heart failure. Therefore, it is possible that FES can benefit patients similarly after cardiac surgery., Objective: This randomized placebo-controlled trial aimed to evaluate the effects of FES on lower limb functional capacity, strength, endurance, and muscle mass after discharge from cardiac surgery., Methods: Twenty patients were allocated (1:1) to the group receiving FES to the quadriceps (FESG) or FES placebo (FESPG). FES was applied at a frequency of 15Hz, with 0.5ms pulse width, 5s contraction time, and 10s resting time, twice a week for 40min over a period of eight weeks. Functional capacity was assessed using the six-minute walk test (6MWT), lower limb muscle strength using the one repetition maximum test (1RM), endurance using the sit-and-stand test (SST), and muscle using the perimeter of the thighs., Results: Both groups increased the distance covered in the 6MWT (FESG: 49.6m, 95% CI 15.9-83.3; FESPG: 41.5m, 95% CI 7.8-75.2), but without a difference between groups. There were significant between-group differences for quadriceps muscle strength (7.2kg, 95% CI 0.2-14.2) and muscle endurance (2.2 repetitions, 95% CI 1.0-3.4) in favor of the FESG., Conclusion: FES improves lower limb muscle strength and endurance in patients after cardiac surgery. Larger trials are needed to confirm our findings., (Copyright © 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Objective: To verify the effectiveness of noninvasive ventilation compared to conventional physiotherapy or oxygen therapy in the mortality rate and prevention of pulmonary complications in patients during the immediate postoperative period of cardiac surgery., Methods: Systematic review and meta-analysis recorded in the International Prospective Register of Ongoing Systematic Reviews (number CRD42016036441). The research included the following databases: MEDLINE, Cochrane Central, PEDro, LILACS and manual search of the references of studies published until March 2016. The review included randomized controlled trials with patients during the immediate postoperative period of cardiac surgery, which compared the use of noninvasive ventilation, BiLevel modes, continuous positive airway pressure, intermittent positive pressure breathing and positive pressure ventilation with conventional physiotherapy or oxygen therapy, and assessed the mortality rate, occurrence of pulmonary complications (atelectasis, pneumonia, acute respiratory failure, hypoxemia), reintubation rate, ventilation time, time spent in the intensive care unit (ICU), length of hospital stay and partial pressure of oxygen., Results: Among the 479 selected articles, ten were included in the systematic review (n=1050 patients) and six in the meta-analysis. The use of noninvasive ventilation did not significantly reduce the risk for atelectasis (RR: 0.60; CI95% 0.28-1.28); pneumonia (RR: 0.20; CI95% 0.04-1.16), reintubation rate (RR: 0.51; CI95%: 0.15-1.66), and time spent in the ICU (-0.04 days; CI95%: -0.13; 0.05)., Conclusion: Prophylactic noninvasive ventilation did not significantly reduce the occurrence of pulmonary complications such as atelectasis, pneumonia, reintubation rate and time spent in the ICU. The use is still unproven and new randomized controlled trials should be carried out.

The aim of this study was to evaluate the effects of low-level laser therapy (LLT) in pressure ulcers (PU) in humans through a systematic review of randomized studies. The search includes the databases MEDLINE, PEDro, Cochrane CENTRAL, and Lilacs, as well a manual search until May, 2016. This included randomized clinical trials of LLT compared with other interventions, different types of LLT, LLT placebo, or control in the treatment of PU. The outcomes evaluated were the ulcer area, healing rate, and overall healing rate. The risk of bias was evaluated using the tool of the Cochrane Collaboration, and the results were analyzed descriptively. From the 386 articles identified, only four studies were included, with two LLT used with single wavelength (1: 904 nm vs. control and 2: 940 nm vs. 808 nm vs. 658 nm vs. placebo) and two LLT used to probe cluster. One study compared to different single wavelengths showed a significant 71% reduction of the PU and an improved healing rate in which 47% of PU healed completely after 1 month of therapy with the use of LLT with a wavelength of 658 nm compared with other lengths. The other analyzed wavelengths were not significant in the assessed outcomes. Significant results were observed in the use of LLT with a 658 nm wavelength, and no evidence was found for use of wavelengths above that for the treatment of PU. Therefore, we also found no evidence in the laser used to probe the cluster.Registration number: CRD42016036648.

Objective: To evaluate and compare the effects of neuromuscular electrical stimulation combined with conventional physical therapy on muscle thickness in critically ill patients., Design: Double-blind, randomized controlled trial., Patients: Twenty-five patients participated in the study., Methods: Patients on mechanical ventilation for 24-48 h were randomized to an intervention group (neuromuscular electrical stimulation + conventional physical therapy) or a conventional group (sham neuromuscular electrical stimulation + conventional physical therapy). Primary outcome was thickness of the rectus abdominis and chest muscles, determined on cross-sectional ultrasound images before and after the intervention., Results: Eleven patients were included in the intervention group and 14 in the conventional group. After neuromuscular electrical stimulation, rectus abdominis muscle thickness and chest muscle thickness were preserved in the intervention group, whereas there was a significant reduction in thickness in the conventional group, with a significant difference between groups. There was a significant difference between groups in length of stay in the intensive care unit, with shorter length of stay in the intervention group., Conclusion: There was no change in rectus abdominis and chest muscle thickness in the intervention group. A significant decrease was found in these measures in the conventional group.

Background: Among neurodegenerative diseases, multiple sclerosis (MS) and amyotrophic lateral sclerosis (ALS) have a high rate of respiratory disability., Objectives: To analyze the effects of respiratory muscle training (RMT) on ventilatory function, muscle strength and functional capacity in patients with MS or ALS., Data Sources: A systematic review and meta-analysis of randomized controlled trials (RCTs) was performed. The sources were MEDLINE, PEDro, Cochrane CENTRAL, EMBASE, and LILACS, from inception to January 2015., Study Selection/eligibility Criteria: The following were included: RCTs of patients with neurodegenerative diseases (MS or lateral ALS) who used the intervention as RMT (inspiratory/expiratory), comparison with controls who had not received RMT full time or were receiving training without load, and evaluations of ventilatory function (forced vital capacity - FVC, forced expiratory volume in one second - FEV1, maximum voluntary ventilation - MVV), respiratory muscle strength (maximal expiratory pressure/maximum inspiratory pressure - MEP/MIP) and functional capacity (6-minute walk test - 6MWT)., Results: The review included nine papers, and a total of 194 patients. It was observed that RMT significantly increased at MIP (23.50cmH2O; 95% CI: 7.82 to 39.19), MEP (12.03cmH2O; 95% CI: 5.50 to 18.57) and FEV1 (0.27L; 95% CI: 0.12 to 0.42) compared to the control group, but did not differ in FVC (0.48L; 95% CI: -0.15 to 1.10) and distance in 6MWT (17.95m; 95% CI: -4.54 to 40.44)., Conclusion: RMT can be an adjunctive therapy in the rehabilitation of neurodegenerative diseases improving ventilatory function and respiratory strength., (Copyright © 2016 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.)

The aim of the current study was to investigate the influence of static stretching on hamstring flexibility in healthy young adults by means of systematic review and meta-analysis. The search strategy included MEDLINE, PEDro, Cochrane CENTRAL, EMBASE, LILACS, and manual search from inception to June 2015. Randomized and controlled clinical trials studies that have compared static stretching to control group, and evaluated range of motion (ROM), were included. On the other hand, studies that have worked with special population such as children, elderly people, athletes, and people with any dysfunction/disease were excluded, as well as articles that have used contralateral leg as control group or have not performed static stretching. The meta-analysis was divided according to three types of tests. Nineteen studies were included out of the 813 articles identified. In all tests, the results favored static stretching compared to control group: passive straight leg raise (12.04; 95% CI: 9.61 to 14.47), passive knee extension test (8.58; 95% CI: 6.31 to 10.84), and active knee extension test (8.35; 95% CI: 5.15 to 11.55). In conclusion, static stretching was effective in increasing hamstring flexibility in healthy young adults.

Background: CHDs form a complex and heterogeneous group of clinical entities, with high morbidity and mortality. With the advancement of surgical and invasive techniques and clinical treatment, the survival of these patients has increased significantly, and there are reports of a high prevalence of ocular abnormalities in this group. The objective of this study was to estimate the prevalence of ocular findings in children and adolescents diagnosed with CHD., Methods: A systematic search was conducted in the following databases: MEDLINE (via PubMed), EMBASE, and Cochrane CENTRAL, in addition to a manual search on studies published on the patient, from inception until August, 2014. Observational studies assessing the prevalence of ocular abnormalities in children and adolescents with CHDs were included., Results: Of the 2413 articles identified, eight were included, comprising a total of 1061 patients. Among them, the lowest and highest prevalences observed were 6.3 and 65%, respectively. The weighted average prevalence of ocular abnormalities was 32.5% (CI95% 19.3-49.3). Strabismus, cataracts, and retinopathy were the most frequently observed alterations., Conclusion: The prevalence of ocular abnormalities in children and adolescents with CHDs was 32.5%, demonstrating that ocular consequences are not uncommon in this population and may have relevant clinical impact. These results reinforce the need for ophthalmological evaluation of patients with CHDs.

Background: Whole body vibration (WBV) has been used to increase physical activity levels in patients with type 2 diabetes mellitus (T2DM)., Objective: To carry out a systematic review of the effects of WBV on the glycemic control, cardiovascular risk factors, and physical and functional capacity of patients with T2DM., Method: MEDLINE, LILACS, PEDro, and Cochrane Central Register of Controlled Trials were searched up to June 1st, 2015. Randomized controlled trials investigating the effects of WBV, compared to control or other intervention, on blood glucose levels, blood and physical cardiovascular risk factors, and physical and functional capacity in adult individuals with T2DM. Two independent reviewers extracted the data regarding authors, year of publication, number of participants, gender, age, WBV parameters and description of intervention, type of comparison, and mean and standard deviation of pre and post assessments., Results: Out of 585 potentially eligible articles, two studies (reported in four manuscripts) were considered eligible. WBV interventions provided a significant reduction of 25.7 ml/dl (95% CI:-45.3 to -6.1; I²: 19%) in 12 hours fasting blood glucose compared with no intervention. Improvements in glycated hemoglobin, cardiovascular risk factors, and physical and functional capacity were found only at 12 weeks after WBV intervention in comparison with no intervention., Conclusion: WBV combined with exercise seems to improve glycemic control slightly in patients with T2DM in an exposure-dependent way. Large and well-designed trials are still needed to establish the efficacy and understand whether the effects were attributed to vibration, exercise, or a combination of both.

Background and Purpose: Neuromuscular electric stimulation (NMES) has been used to reduce spasticity and improve range of motion in patients with stroke. However, contradictory results have been reported by clinical trials. A systematic review of randomized clinical trials was conducted to assess the effect of treatment with NMES with or without association to another therapy on spastic muscles after stroke compared with placebo or another intervention., Methods: We searched the following electronic databases (from inception to February 2015): Medline (PubMed), EMBASE, Cochrane Central Register of Controlled Trials and Physiotherapy Evidence Database (PEDro). Two independent reviewers assessed the eligibility of studies based on predefined inclusion criteria (application of electric stimulation on the lower or upper extremities, regardless of NMES dosage, and comparison with a control group which was not exposed to electric stimulation), excluding studies with <3 days of intervention. The primary outcome extracted was spasticity, assessed by the Modified Ashworth Scale, and the secondary outcome extracted was range of motion, assessed by Goniometer., Results: Of the total of 5066 titles, 29 randomized clinical trials were included with 940 subjects. NMES provided reductions in spasticity (-0.30 [95% confidence interval, -0.58 to -0.03], n=14 randomized clinical trials) and increase in range of motion when compared with control group (2.87 [95% confidence interval, 1.18-4.56], n=13 randomized clinical trials) after stroke., Conclusions: NMES combined with other intervention modalities can be considered as a treatment option that provides improvements in spasticity and range of motion in patients after stroke., Clinical Trial Registration Information: URL: http://www.crd.york.ac.uk/PROSPERO. Unique identifier: CRD42014008946., (© 2015 American Heart Association, Inc.)

Objective: To assess the effects of physical activity interventions in preventing cardiovascular risk factors in childhood through a systematic review and meta-analysis of randomized clinical trials (RCTs)., Methods: A search of online databases (PubMed, EMBASE and Cochrane CENTRAL) was conducted from inception until June 2013. RCTs enrolling children 6-12years old conducted physical activity interventions longer than 6months, assessing their effect on body mass index (BMI), systolic (SBP) and diastolic blood pressure (DBP), total cholesterol (TC) and triglycerides (TG) were included. Data analysis was performed using a random-effects model., Results: Of 23.091 articles retrieved, 11 RCTs (10.748 subjects) were included. Physical activity interventions were not associated with reductions of BMI [-0.03kg/m(2) (95%CI -0.16, 0.13) I(2) 0%]. However, there was an association between the interventions and reduction of SBP [-1.25mmHg (95%CI -2.47, -0.02) I(2) 0%], DBP [-1.34mmHg (95%CI -2.57, -0.11) I(2) 43%] and TG [-0.09mmol/L (95%CI -0.14, -0.04) I(2) 0%], and increase of TC [0.14mmol/L (95%CI 0.01, 0.27) I(2) 0%]., Conclusion: As physical activity intervention programs lasting longer than 6months are associated with reductions in blood pressure levels and triglycerides, they should be considered to be included in prevention programs for cardiovascular diseases in schoolchildren., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: Obstructive sleep apnea (OSA) may lead to the development of hypertension and therapy with continuous positive airway pressure (CPAP) can promote reduction in blood pressure., Objective: The objective of this study is to review systematically the effects of CPAP on blood pressure in patients with OSA., Methods: The search was conducted in the following databases, from their beginning until February 2013: MEDLINE, Embase, Cochrane CENTRAL, Lilacs and PEDro. In addition, a manual search was performed on references of published studies. Randomized clinical trials (RCTs) that used CPAP compared with placebo CPAP or subtherapeutic CPAP for treatment of patients with OSA and that evaluated office SBP and DBP and 24-h ambulatory blood pressure were selected., Results: Sixteen RCTs were included among 3409 publications, totaling 1166 patients. The use of CPAP resulted in reductions in office SBP [-3.20  mmHg; 95% confidence interval (CI) -4.67 to -1.72] and DBP (-2.87  mmHg; 95% CI -5.18 to -0.55); in night-time SBP (-4.92  mmHg; 95% CI -8.70 to -1.14); in mean 24-h blood pressure (-3.56  mmHg; 95% CI -6.79 to -0.33), mean night-time blood pressure (-2.56  mmHg; 95% CI -4.43 to -0.68) and 24-h DBP (-3.46  mmHg; 95% CI -6.75 to -0.17). However, no significant change was observed in daytime SBP (-0.74  mmHg; 95% CI -3.90 to 2.41) and daytime DBP (-1.86  mmHg; 95% CI -4.55 to 0.83)., Conclusion: Treatment with CPAP promoted significantly but small reductions in blood pressure in individuals with OSA. Further studies should be performed to evaluate the effects of long-term CPAP and the impact on cardiovascular risk.

The objective of this study was to find out whether there are gender dierences regarding socio-demographic characteristics and associated risk factors in adults monitored in an outpatient hypertension facility. Retrospective analysis of records of patients seen at the outpatient hypertension clinic in 2009-2010, in a hospital specialized in cardiology, in southern Brazil. All patients were beneficiaries from the Brazilian Unified Healthcare System (SUS). The variables considered were socio-demographicprofile, anthropometric measurements and risk factors for hypertension. For statistical analysis, a signficance level of 5% (p < 0.05) was adopted. Of the 209 patient records assessed most belonged to female patients (66%), 65.9% of them were married 71.6% were white, with mean age 53.5 +/- 13.8 years, and 70.1% had a sedentary behavior Regarding risk factors, waist circumference and alcohol use were higher among men (p = 0.04). It was concluded that there was no gender difference concerning the assessed variables, except for the use of alcohol.

Background: Inverse associations between micronutrient intake and cardiovascular outcomes have been previously shown, but did not focus on diabetic patients., Objective: To systematically review the role of micronutrients in the development/presence of cardiovascular outcomes in patients with diabetes., Methods: We searched Medline, Embase, and Scopus (January/1949-March/2012) for observational studies that evaluated micronutrients and cardiovascular outcomes in patients with diabetes, and then selected and extracted the data (two independent reviewers)., Results: From the 15 658 studies identified, five were included, comprising three case-control and two cohorts, with a follow-up of 7-15 years. A meta-analysis was not performed due to the different antioxidant micronutrients (types and measurement methods) and outcomes evaluated. The micronutrients assessed were vitamin C intake in diet and/or supplementation, chromium and selenium in toenail samples, and α-tocopherol and zinc in serum levels. Intake of >300 mg of vitamin C through supplementation was associated with increased risk of cardiovascular disease, coronary artery disease (CAD), and stroke (RR 1.69-2.37). High levels of α-tocopherol in serum were associated with 30% lower CAD risk in another study (HR 0.71; 95%CI 0.53-0.94). Among minerals (zinc, selenium, and chromium), an inverse association between zinc and CAD was observed; levels lower than 14.1 µmol/L were associated with an increased risk for CAD (RR 1.70; 95%CI 1.21-2.38)., Conclusion: The information available on this issue is scarce. Further prospective studies are needed to elucidate the role of these nutrients in the cardiovascular risk of patients with diabetes.

Tight control of blood glucose reduces cardiovascular events and total mortality is conflicting. To summarize clinical effects of tight versus conventional glucose control in patients with type 2 diabetes. We systematically searched MEDLINE, EMBASE, Cochrane Library, and ISI Web of Knowledge with no limits of language and time. Further trials were searched from the reference lists of identified studies. We included randomized controlled comparing different levels of blood glucose control intensity in type 2 diabetic patients. Two independent reviewers extracted data of eligible studies using standard case report forms. We investigated total mortality, cardiovascular and microvascular events, and hypoglycemia in patients with type 2 diabetes. We used random-effects models to obtain relative risks (RR) with 95% confidence intervals (CI). We included 6 trials involving 27,654 patients. There was no significant effect of tight blood glucose control on all-cause mortality (RR 1.03; 95% CI 0.90-1.17) or cardiovascular mortality (RR 1.04; 95% CI 0.83-1.29). Tight glucose control reduced the risk for nonfatal MI (RR 0.85; 95% CI 0.76-0.95), although had no effect on the incidence of nonfatal stroke (RR 1.02; 95% CI 0.88-1.17). For microvascular events, tight glucose control reduced the risk progression of retinopathy (RR 0.80; 95% CI 0.71-0.91), incidence of peripheral neuropathy (RR 0.94; 95% CI 0.89-0.99), and progression of nephropathy (RR 0.55; 95% CI 0.37-0.80), but had not significant effect on the incidence of nephropathy (RR 0.69; 95% CI 0.42-1.14). The risk of severe hypoglycemia increased with tight glucose control (RR 2.39; 95% CI 1.79-3.18). Tight blood glucose control reduces the risk for some macrovascular and microvascular events, without effect on all-cause mortality and cardiovascular mortality. Tight glucose control increases the risk of severe hypoglycemia., (© 2011 Blackwell Publishing Ltd.)

Objective: To assess the effectiveness of educational interventions including behavioral modification, nutrition and physical activity to prevent or treat childhood obesity through a systematic review and meta-analysis of randomized trials., Method: A search of databases (PubMed, EMBASE and Cochrane CENTRAL) and references of published studies (from inception until May 2012) was conducted. Eligible studies were randomized trials enrolling children 6 to 12 years old and assessing the impact of educational interventions during 6 months or longer on waist circumference, body mass index (BMI), blood pressure and lipid profile to prevent or treat childhood obesity. Calculations were performed using a random effects method and pooled-effect estimates were obtained using the final values., Results: Of 22.852 articles retrieved, 26 trials (23.617 participants) were included. There were no differences in outcomes assessed in prevention studies. However, in treatment studies, educational interventions were associated with a significant reduction in waist circumference [-3.21 cm (95%CI -6.34, -0.07)], BMI [-0.86 kg/m(2) (95%CI -1.59, -0.14)] and diastolic blood pressure [-3.68 mmHg (95%CI -5.48, -1.88)]., Conclusions: Educational interventions are effective in treatment, but not prevention, of childhood obesity and its consequences., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: Painful diabetic neuropathy (PDN) is a common complication of diabetes mellitus, and pharmacological therapies are ineffective in many patients. Therefore, other treatment modalities should be considered, including electrical stimulation and electromagnetic fields., Objectives: The research objective was to evaluate the effect of treatment with electrical stimulation and electromagnetic fields on pain and sensitivity in patients with painful diabetic neuropathy compared with placebo or another intervention., Method: We searched the following electronic databases (from inception to April 2012): MEDLINE (accessed by PubMed), LILACS, Physiotherapy Evidence Database (PEDro), EMBASE and Cochrane CENTRAL. We included randomized trials that compared electrical stimulation or electromagnetic fields with control groups in which the objective was to assess pain and sensitivity in patients with PDN. Two reviewers independently extracted the data. A random-effects model was used for the main analysis., Results: The search retrieved 1336 articles, of which 12 studies were included. Reductions in the mean pain score were significantly greater in the TENS (transcutaneous electrical nerve stimulation) group than in the placebo group [-0.44 (95% CI: -0.79 to -0.09; I2: 0%)]. There was no improvement in pain relief when electromagnetic fields were compared with the control group [-0.69 (95% CI: -1.86 to 0.48; I2: 63%)]., Conclusions: We found that TENS improved pain relief in patients with diabetic neuropathy, while no such improvement was observed with the use of electromagnetic field treatment. Due to the methodological differences between the studies, a meta-analysis for the outcome of sensitivity could not be performed.

Patients with chronic heart failure (CHF) may have lower inspiratory muscle strength and endurance, which may contribute to exercise intolerance. Inspiratory muscle training (IMT) can have beneficial effects on these patients. Thus, the aim of this study was to systematically review the effects of IMT compared to control groups (placebo-IMT or another intervention) in patients with CHF. A search of databases (MEDLINE, Cochrane CENTRAL and PEDro) and references of published studies, from 1960 to 2011, was conducted. Randomized trials comparing IMT to control groups in the treatment of patients with CHF were included. The GRADE approach was used to determine the quality of evidence for each outcome. Of 119 articles identified, 7 studies were included. IMT increased the distance walked in the six-minute walk test [69 m (95% CI: 7.21 to 130.79)] (very low evidence) and maximal static inspiratory pressure [23.36 cmH20 (95% CI: 11.71 to 35.02)] (low evidence) compared to control groups. However, IMT provides a significant improvement in peak oxygen consumption only in the studies that performed IMT for 12 weeks against no inspiratory load in patients with inspiratory muscle weakness [3.02 ml/kg/min-1 (95% CI: 0.43 to 5.61)]. IMT improves functional capacity and inspiratory muscle strength thereby deserving consideration as an additional intervention in patients with CHF. Larger and better-designed studies, however, are needed to clarify the potential benefit of IMT in this patient population.