Exercise Test – ABC CARDIOL

IJCS

Original Article

Feasibility and Safety of One-Minute Step Test in Patients with Heart Failure Hospitalized in the Cardio-Intensive Care Unit: A Pilot Study.

Andresa Narcizo Volotão et al. Clara Pinto Diniz Ana Carolina Cossio Rodriguez Vivian de Freitas Martins da Silva … Juliana Rega de Oliveira Ana Paula Nunes Carneiro Mariana Barcellos de Avila Carolina Nigro Di Leone

Abstract

Background:

The One-Minute Step Test (1MST) seems to be a useful tool for exploring the component of energy metabolism used in Activities of Daily Living (ADL), but it is still little explored in patients with Heart Failure (HF) in the hospital environment.

Objective:

To evaluate the feasibility and safety of performing 1MST in hospitalized patients with HF.

Methods:

Data were collected using electronic medical records and evaluative tests from patients with HF. The safety of the 1MST was assessed through vital signs records, perceived exertion, adverse events, and feasibility based on the ability to complete the test. The paired Student’s T-test and Wilcoxon test were employed to compare the data before and after the test, depending on the distribution of the data, while the relationship between the variables was examined using Pearson’s correlation test. The significance level set was p < 0.05.

Results:

Twenty patients were evaluated between May and December 2022. All patients completed the test, and no adverse events were recorded. Heart rate (HR) (p < 0.001), systolic blood pressure (SBP) (p = 0.01), mean arterial pressure (MBP) (p = 0.03), and respiratory rate (p < 0.001), and peripheral oxygen saturation showed a reduction (p = 0.04). A negative correlation was observed between 1MST and age (r = −0.46; p = 0.03) and a positive correlation between 1MST and length of stay in the CICU (r = 0.44; p = 0.04).

Conclusion:

It is concluded that the 1MST is a safe and viable tool for assessing the anaerobic metabolism of patients with HF.

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IJCS

Case Report

ECG's AVR ST elevation Analysis by Perfusion Scintilography in the Context of Myocardial Ischemia

Miriana Basso Gomes et al. Carolina Feijó Bombana Felipe C. Fuchs

Introduction

The presence of ST-segment elevation in two or more contiguous leads indicates a current subepicardial lesion that often requires early intervention, either by angioplasty or thrombolytic therapy.^, ST elevation, only in aVR, may also indicate the presence of an acute infarction. This finding was first made by Wellens et al. However, this is not always true, and physicians should be aware of the details surrounding changes in Right Vector amplification (aVR).

The medical literature has a wide range of articles reporting on the association between ST elevation in aVR during exercise testing and left main coronary artery injury.^– However, this concept began at a time when fewer imaging tests and catheterizations were performed. Altered stress tests are a common indication of myocardial scintigraphy, which is why the Nuclear Medicine laboratory is the perfect place to perform this type of analysis. There is now evidence that aVR elevation in this context may not indicate coronary lesions and may be present, for example, in patients with aortic stenosis, hypertrophy and hypoxia..^– Since these are stress tests, it is important to analyze the heart rate in which the aVR elevation occurs as well as the pattern of the other leads.

[…]

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IJCS

Editorial

Exercise-induced Bronchoconstriction and its Relevance in Public Health

Tales de Carvalho

The case report from Castro et al., entitles Exercise-Induced Bronchoconstriction: A Frequent, but Neglected Cause of Chest Pain, opportunely sheds light on a highly relevant question in terms of public health, as it treats important aspects that encompass from the diagnosis to the pharmacological treatment of Exercise-Induced Bronchoconstriction (EIB).^–

EIB often leads to an isolated cough, as well as thoracic and abdominal pain, which should always be contemplated after having discarded other causes of dyspnea and exercise-induced chest pain.^– It is an acute airway obstruction that is transitory and spontaneously reversible, and occurs during and after exercise and physical effort, regardless of the previous diagnosis of bronchial asthma. EIB normally arises 2 to 5 min after exercise, reaching a peak at 10 min and disappearing in up to 60 min.^,,

[…]

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IJCS

Original Article

Physical Fitness Test (PFT) in Police and Military in Brazil: A Systematic Review

Bráulio Nascimento Lima et al. Renato Silveira de Assis Junior Klebson da Silva Almeida Leandro Borelli de Camargo … Ricardo Pablo Passos Carlos Henrique Prevital Fileni Divaldo Martins de Souza Guanis de Barros Vilela Junior

Abstract

Background

Physical Fitness Tests (PFTs) are part of military routines and are usually administered to applicants for the Brazilian corps member, including the civil police.

Objective

To identify in the literature, scientific articles aimed at assessing physical fitness of police and military personnel in Brazil, using PFTs.

Methods

This was a systematic review, using the PRISMA systematization, using the following search keywords “police”, “military”, “physical fitness test” and ” PFT”, in English and Portuguese. The databases used were ScienceDirect, PubMed, BVS (Lilacs) and Scielo. Only original works performed with police and military personnel in Brazil were selected, through the application of inclusion and exclusion criteria.

Results

After the screening process, 11 articles were selected from a total of 1,487.

Conclusions

The data collected from the selected articles suggest that older age is related to a decrease in physical fitness, and better performance in the tests is related to a lower risk of comorbidities. Although high-intensity training improves physical fitness and anthropometric data, it is associated with injury rates; physically active lifestyle is associated with better flexibility.

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IJCS

Original Article

Comparison between Bruce and Ramp Protocols for Exercise Testing in the Diagnosis of Myocardial Ischemia

Thiago Teixeira da Silveira Fagundes et al. Carolina Christianini Mizzaci Susimeire Buglia Fabricio da Costa Wohnrath … Flavia Medina João França Rica Dodo Delmar Buchler Luiz Eduardo Mastrocola Romeu Sérgio Meneghelo

Abstract

Background:

Exercise tests are an important tool in the investigation of myocardial ischemia. The ramp protocol has gained increasing importance in clinical practice because of the possibility of individualizing its exercise intensity.

Objective:

To assess and compare the sensitivity, specificity, and accuracy of Bruce and ramp protocols for exercise testing in the diagnosis of myocardial ischemia considering myocardial perfusion scintigraphy as the reference standard. Secondary objectives included the assessment of hemodynamic profiles, functional capacity, and the incidence of arrhythmias in each of the protocols.

Methods:

Participants underwent exercise testing using the ramp and Bruce protocols, and the tests’ diagnostic power was assessed. For testing the difference between data provided by both protocols, we used a paired Student’s t-test or Wilcoxon test, depending on the assumption of data normality. The level of significance adopted for all tests was 5%.

Results:

The ramp protocol showed sensitivity, specificity, and accuracy values of 55.6%, 82.4%, and 76.7%, respectively, whereas the Bruce protocol had results of 77.8%, 64.7%, and 67.4%, respectively. The maximum heart rate and double product at peak exercise were significantly higher in the Bruce protocol (p = 0.043 and p = 0.040, respectively). No differences were observed between the incidence of arrhythmias in both protocols.

Conclusion:

The Bruce protocol presented higher sensitivity for detecting ischemia on the exercise test, while the ramp protocol presented higher specificity and accuracy.

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IJCS

Original Article

Exercise Testing, Family History, and Subclinical Atherosclerosis Markers for Cardiovascular Risk Reclassification in Middle-Aged Women

Ricardo Quental Coutinho et al. Ulisses Ramos Montarroyos Isly Maria Lucena de Barros Maria José Bezerra Guimarães … Ana Paula Dornelas Leão Laura Olinda Bregieiro Fernandes Costa Ana Kelley de Lima Medeiros Maria de Fátima Monteiro Moacir de Novaes Lima Ferreira William Azem Chalela Rodrigo Pinto Pedrosa

Abstract

Background

Cardiovascular diseases are the main cause of death in women and the accuracy of currently available risk scores is questionable.

Objective

To reclassify the risk estimated by the Framingham Risk Score (FRS) in asymptomatic middle-aged women by incorporating family history, exercise testing variables, and subclinical atherosclerosis markers.

Methods

This cross-sectional study included 509 women (age range, 46-65 years) without cardiovascular symptoms. Those at low or intermediate risk by the FRS were reclassified to a higher level considering premature family history of acute myocardial infarction and/or sudden death; four variables from exercise testing; and two variables related to subclinical atherosclerosis markers. The homogeneity of these variables according to the FRS was verified by Pearson chi-square test (p<0.05).

Results

According to the FRS, 80.2%, 6.2%, and 13.6% of the women were classified as low (10%) risks, respectively. The intermediate-risk stratum showed the highest increase (from 6.2% to 33.3%) with addition of family history; followed by addition of chronotropic index <80% (to 24.2%); functional capacity 0 (20.6%); decreased one-minute heart rate recovery ≤12 bpm (15.2%); carotid intima-media thickness >1 mm and/or carotid plaque (13.8%) and ST-segment depression (9.0%). The high-risk stratum increased to 14.4% with the addition of reduced heart rate recovery and to 17.1% with the coronary calcium score.

Conclusion

Incorporation of premature family history of cardiovascular events, exercise testing abnormal parameters, and subclinical atherosclerosis markers into the FRS led to risk reclassification in 3.0-29.7% of asymptomatic middle-aged women, mainly by an increase from low to intermediate risk.

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IJCS

Case Report

Exercise Training Improved Pulmonary Gas Exchange Abnormalities in Pulmonary Hypertension due to Heart Failure: A Case Report

Danilo Marcelo Leite do Prado et al. Enéas Antônio Rocco Júlia de Paiva Fonseca de Campos Thais Pellegrino Miranda … Amanda Barbuio Teixeira Michele Staroste Emmanuel Gomes Ciolac

Abstract

Heart failure (HF) is the most common cause of pulmonary hypertension (PH), and reduced exercise capacity and exertional dyspnea are the most frequent concerns in patients with PH-HF. Indeed, carbon dioxide end-tidal partial pressure (PETCO ₂ ) during exercise is a well-established noninvasive marker of ventilation/perfusion ratio in PH. We aimed to evaluate the effect of aerobic exercise training on PETCO ₂ response during exercise in a 59-year-old woman with PH secondary to idiopathic dilated cardiomyopathy. The patient with chronic fatigue and dyspnea at mild-to-moderate efforts was admitted to a cardiorespiratory rehabilitation program and had her cardiorespiratory response to exercise assessed during a cardiopulmonary exercise testing performed before and after three months of a thrice-weekly aerobic exercise training program. Improvements in aerobic capacity (23.9%) and endurance time (37.5%) and reduction in ventilatory inefficiency (-20.2%) was found after intervention. Post-intervention improvements in PETCO ₂ at ventilatory anaerobic threshold (23.3%) and change in PETCO ₂ kinetics pattern, with progressive increases from rest to peak of exercise, were also found. Patient also improved breathing pattern and timing of ventilation. This case report demonstrated for the first time that aerobic exercise training might be able to improve PETCO ₂ response during exercise in a patient with PH-HF.

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IJCS

Original Article

Comparative Analysis of Direct and Indirect Methods for the Determination of Maximal Oxygen Uptake in Sedentary Young Adults

Alfredo Moreira da Rocha Neto et al. Artur Haddad Herdy Pablo de Souza

Abstract

Background:

Maximal oxygen uptake is a powerful prognostic indicator and a reliable measure of physical conditioning. It can be measured directly by cardiopulmonary exercise testing (CPET) or indirectly by formulas derived from conventional protocols.

Objective:

We compared the VO₂ max obtained by formula using exercise testing with Bruce protocol (BP) with the VO₂ max obtained by CPET on the treadmill.

Methods:

We selected 41 healthy, non-obese, physically inactive young volunteers, aged between 21 and 50 years, residents of Florianópolis, Brazil.

Results:

Twenty-one women (52%) with mean age of 35.62 ± 8.83 years, and 20 males, with mean age of 32.5 ± 7.18 years participated in the study. Statistically significant differences were found for VO₂ max between the two methods (BP – 42.31 ± 5.21 ml/kg.min vs. CPET – 30.46 ± 5.50 ml/kg.min., p < 0.0001). The Bruce formula overestimated the result by 34.1% (BP – 45.95 ± 3.94 ml/kg.min vs. CPX – 34.27 ± 4.20 ml/kg.min, p < 0.0001) for men, and by 44.8% (BP – 38.84 ± 3.72 ml/kg.min vs. CPX – 26.83 ± 3.90, p < 0.0001) for women. A moderate correlation was observed between the methods (r = 0.65). When classifying the results according to the table of aerobic capacity of the American Heart Association, the agreement was null (kappa = 0.0034; Pearson chi2 = 0.001).

Conclusion:

VO₂ estimated by BP is not capable of demonstrating the true aerobic capacity in these individuals, while CPET is an important tool for early detection of diminished functional capacity in sedentary young men and women.

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IJCS

Original Article

Speed and Grade Increment During Cardiopulmonary Treadmill Testing: Impact on Exercise Prescription

Karlyse C. Belli et al. Paula F. Da Silva Leandro T. Franzoni Jonathan Myers … Ricardo Stein Jorge P. Ribeiro

Abstract

Background:

Maximal oxygen uptake (VO₂max) and both first (VT₁) and second (VT₂) thresholds have been used as reference points for exercise prescription in different populations.

Objective:

We aimed to test the hypothesis that exercise prescription, based on VTs determined by treadmill cardiopulmonary exercise testing (CPET), is influenced by the rate of increase in treadmill workload.

Methods:

Nine healthy individuals underwent two CPETs, followed by two sessions of submaximal exercise, both in randomized order. For the “speed” protocol, there was an increment of 0.1 to 0.3 km.h^-1 every 15s. The “grade” incremental protocol increased 1% every 30s and 0.1 km.h^-1 every 45s. This was followed by submaximal exercise sessions lasting 40min at an intensity corresponding to heart rate (HR) between the VT₁ and VT₂.

Results:

The “speed” protocol resulted in higher VT₁ (p = 0.01) and VT₂ (p = 0.02) when compared to the “grade” incremental protocol, but there was no effect on VO₂max. The target HR for the submaximal exercise sessions was higher in the “speed” protocol compared to the “grade” incremental protocol (p < 0.01) and remained stable during the two steady-state exercise sessions. Blood lactate remained stable during the submaximal exercise sessions, with higher values observed during the “speed” protocol than those “grade” incremental protocol (p < 0.01).

Conclusions:

Compared to a grade-based protocol, a speed-based protocol resulted in higher VT₁ and VT₂, which significantly affected cardiorespiratory and metabolic responses to prescribed exercise intensity in healthy young adults.

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IJCS

Original Article

CLINIMEX Aerobic Fitness Questionnaire: Proposal and Validation

Claudio Gil S. Araújo et al. Claudia Lucia Castro João Felipe Franca Christina Grüne de Souza e Silva

Abstract

Background:

Cardiorespiratory (aerobic) fitness is strongly and directly related to major health outcomes, including all-cause mortality. Maximum oxygen uptake (VO₂max), directly measured by maximal cardiopulmonary exercise test (CPET), represents the subject’s aerobic fitness. However, as CPET is not always available, aerobic fitness estimation tools are necessary.

Objectives:

a) to propose the CLINIMEX Aerobic Fitness Questionnaire (C-AFQ); b) to validate C-AFQ against measured VO₂max; and c) to analyze the influence of some potentially relevant variables on the error of estimate.

Methods:

We prospectively studied 1,000 healthy and unhealthy subjects (68.6% men) aged from 14 to 96 years that underwent a CPET. The two-step C-AFQ describes physical activities with corresponding values in metabolic equivalents (METs) – ranging from 0.9 to 21 METs.

Results:

Application of C-AFQ took less than two minutes. Linear regression analysis indicated a very strong association between estimated (C-AFQ) and measured (CPET) maximal METs – r2 = 0.83 (Sy.x = 1.63; p < .001) – with median difference of only 0.2 METs between both values and interquartile range (percentiles 25 and 75) of 2 METs. The difference between estimated and measured METs was not influenced by age, sex, body mass index, clinical condition, ß-blocker use or sitting-rising test scores.

Conclusion:

C-AFQ is a simple and valid tool for estimating aerobic fitness when CPET is unavailable and it is also useful in planning individual ramp protocols. However, individual error of estimate is quite high, so C-AFQ should not be considered a perfect substitute for CPET’s measured VO₂max.

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IJCS

Original Article

Correlation between Exercise Stress Test and Echocardiographic Parameters in Elderly Individuals

Liz Andréa Villela Baroncini et al. Camila Varotto Baroncini Juliana Ferreira Leal

Abstract

Background:

Maximum oxygen consumption (VO₂ max) in healthy individuals decreases approximately 10% per decade of life, and such decrease is more pronounced after the seventh decade.

Objectives:

To assess functional capacity of individuals aged 75 years or older, submitted to ergometric test and transthoracic echocardiogram exam, by means of metabolic equivalent (MET) and VO₂ max measurements.

Methods:

A total of 381 patients (205 women; 79 ± 3.7 years) were evaluated. Exclusion criteria were: presence of left ventricular (LV) systolic dysfunction, LV diastolic dysfunction grade II and III, significant valve disease, or coronary artery disease with systolic LV dysfunction or dilatation. Associations between quantitative variables were analyzed by Pearson and Spearman correlation coefficients, and comparisons of quantitative data by Student’s t-test for independent samples.

Results:

Increasing age was associated with a progressive decrease in the distance covered (p = 0.021), in the expected increase in HR (p < 0.001), in VO₂ max (p < 0.001), and METs (p < 0.001) in both genders. There was no correlation of exercise test parameters with the echocardiographic parameters.

Conclusions:

Relatively healthy older individuals, with global systolic and diastolic functions of the left ventricle preserved, presented a progressive decrease in their functional capacity due to their natural aging process, comorbidities related to their age range and physical deconditioning.

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Original Article

Hemodynamic, Metabolic and Ventilatory Responses to Exercise in Adults with Congenital Heart Disease

Pablo Marino Corrêa Nascimento et al. Daniel Arkader Kopiler Fernando Cesar de Castro e Souza Maria Carolina Terra Cola … Marina Pereira Coelho Gabriella de Oliveira Lopes Eduardo Tibiriçá

Abstract

Background:

Congenital heart disease in adults shares some features with heart failure (HF), including exercise intolerance, ventilatory inefficiency, inflammatory and neurohormonal activation, cardiac arrhythmias and myocardial fibrosis. Over the last years, cardiopulmonary exercise test has gained importance in the diagnostic and prognostic evaluation of congenital heart diseases, as has already occurred in HF.

Objective:

To describe the behavior of hemodynamic, metabolic and ventilatory parameters in response to exercise in adults with congenital heart disease.

Methods:

Observational cross-sectional study evaluating 31 adults with congenital acyanotic or cyanotic heart disease, treated clinically, surgically or percutaneously, referred for cardiopulmonary exercise test. A descriptive analysis of the data was performed.

Results:

Patients aged 35.7 ± 14.2 years were included. Oxygen consumption (VO₂) was 44.86 ± 18.01% of predicted at peak exercise and 36.92 ± 12.93% of predicted maximal VO₂ at anaerobic threshold. We found an oxygen uptake efficiency slope (OUES) of 1.49 ± 0.89 (61.43 ± 26.63% of predicted), oxygen pulse of 58.90 ± 22.24% and increment in systolic arterial pressure during exercise was 31.42 ± 21.60 mmHg.

Conclusion:

Adults with congenital heart disease had similar responses to heart failure patients during exercise – reduced aerobic capacity, ventilatory inefficiency for oxygen consumption and limited inotropic response to exercise, characterized by reduced oxygen pulse and small increase in systolic arterial pressure.

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Original Article

Comparison betweent the Effects of Swimming and Treadmill-Based Aerobic Training Protocols in Diabetic Rats

Elizabeth de Orleans Carvalho de Moura et al. Kelvin Tanaka Moisés Felipe Pereira Gomes Evandro Nogueira … Ricardo Gomes Debora Estadella Katt Mattos Patrícia Chakur Brum Alessandra Medeiros

Abstract

Background:

Type 1 diabetes mellitus (DM1) can cause damage to several physiological systems.

Objectives:

To compare and characterize the effects of aerobic exercise training (ET) performed by swimming with those of ET performed on a treadmill on the skeletal muscle and heart of rats with DM1.

Methods:

41 male Wistar rats were randomized into four groups: nondiabetic control (CTR), diabetic control (DMC), diabetic trained on the treadmill (DMT), and diabetic trained by swimming (DMS). The trained groups performed aerobic exercise training for 8 weeks, 5 times a week, 60 min per day. Exercise tolerance, blood glucose, body weight, wet weight of the skeletal muscles and left ventricle (LV), muscle glycogen, cross-sectional area of skeletal muscles, and cross-sectional diameter and collagen volume fraction of the LV were evaluated.

Results:

The results were expressed as mean ± standard deviation of the mean and submitted to two-way ANOVA with post-hoc Bonferroni test. Aerobic ET protocols applied to animals with DM1, regardless of the ergometer, showed satisfactory results (p < 0.05) when compared to the control groups: improved exercise tolerance, increased glycogen content of the soleus and extensor digitorum longus (EDL) muscles and increased cross-sectional diameter of the left ventricular cardiomyocytes. In some variables, such as exercise tolerance and cross-sectional area of the soleus and EDL muscles, DMT showed better results than DMS (p < 0.05). On the other hand, DMS showed increased cross-sectional diameter of cardiomyocytes when compared with the DMT group.

Conclusion:

Both aerobic ET protocols offered benefits to animals with diabetes; however, due to the specific characteristics of each modality, different physiological adaptations were observed between the trained groups.

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ABC

Original Article

Safety, feasibility, and results of exercise testing for stratifying patients with chest pain in the emergency room

Renato Machado Macaciel et al. Evandro Tinoco Mesquita Ricardo Vivacqua Salvador Serra … Augusta Campos Marcelo Miranda Roberto Gamarski Hans Dohman Roberto Bassan

OBJECTIVE: To assess safety, feasibility, and the results of early exercise testing in patients with chest pain admitted to the emergency room of the chest pain unit, in whom acute myocardial infarction and high-risk unstable angina had been ruled out. METHODS: A study including 1060 consecutive patients with chest pain admitted to the emergency room of the chest pain unit was carried out. Of them, 677 (64%) patients were eligible for exercise testing, but only 268 (40%) underwent the test. RESULTS: The mean age of the patients studied was 51.7±12.1 years, and 188 (70%) were males. Twenty-eight (10%) patients had a previous history of coronary artery disease, 244 (91%) had a normal or unspecific electrocardiogram, and 150 (56%) underwent exercise testing within a 12-hour interval. The results of the exercise test in the latter group were as follows: 34 (13%) were positive, 191 (71%) were negative, and 43 (16%) were inconclusive. In the group of patients with a positive exercise test, 21 (62%) underwent coronary angiography, 11 underwent angioplasty, and 2 underwent myocardial revascularization. In a univariate analysis, type A/B chest pain (definitely/probably anginal) (p<0.0001), previous coronary artery disease (p<0.0001), and route 2 (patients at higher risk) correlated with a positive or inconclusive test (p<0.0001). CONCLUSION: In patients with chest pain and in whom acute myocardial infarction and high-risk unstable angina had been ruled out, the exercise test proved to be feasible, safe, and well tolerated.

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ABC

Original Article

Exercise testing in hypertensive patients taking different angiotensin-converting enzyme inhibitors

Maria Angela M. Q. Carreira et al. Leandro R. Tavares Rafaela F. Leite Jamila C. Ribeiro … Antônio C. Santos Karla G. Pereira Guilhermo C. Velarde Antonio Claudio L. Nóbrega

OBJECTIVE: To compare blood pressure response to dynamic exercise in hypertensive patients taking trandolapril or captopril. METHODS: We carried out a prospective, randomized, blinded study with 40 patients with primary hypertension and no other associated disease. The patients were divided into 2 groups (n=20), paired by age, sex, race, and body mass index, and underwent 2 symptom-limited exercise tests on a treadmill before and after 30 days of treatment with captopril (75 to 150 mg/day) or trandolapril (2 to 4 mg/day). RESULTS: The groups were similar prior to treatment (p<0.05), and both drugs reduced blood pressure at rest (p<0.001). During treatment, trandolapril caused a greater increase in functional capacity (+31%) than captopril (+17%; p=0.01) did, and provided better blood pressure control during exercise, observed as a reduction in the variation of systolic blood pressure/MET (trandolapril: 10.7±1.9 mmHg/U vs 7.4±1.2 mmHg/U, p=0.02; captopril: 9.1±1.4 mmHg/U vs 11.4±2.5 mmHg/U, p=0.35), a reduction in peak diastolic blood pressure (trandolapril: 116.8±3.1 mmHg vs 108.1±2.5 mmHg, p=0.003; captopril: 118.2±3.1 mmHg vs 115.8±3.3 mmHg, p=0.35), and a reduction in the interruption of the tests due to excessive elevation in blood pressure (trandolapril: 50% vs 15%, p=0.009; captopril: 50% vs 45%, p=0.32). CONCLUSION: Monotherapy with trandolapril is more effective than that with captopril to control blood pressure during exercise in hypertensive patients.

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Original Article

Unsupervised Rehabilitation: effects of Exercise Training over the Long Run

Japy Angelini Oliveira Filho et al. Ana Cristina Leal Valter Correia Lima Dirceu Vieira Santos Filho Bráulio Luna Filho

OBJECTIVE: To assess the safety and efficacy of unsupervised rehabilitation (USR) in the long run in low-risk patients with coronary artery disease. METHODS: We carried out a retrospective study with 30 patients divided into: group I (GI) – 15 patients from private clinics undergoing unsupervised rehabilitation; group II (GII) – control group, 15 patients from ambulatory clinic basis, paired by age, sex, and clinical findings. GI was stimulated to exercise under indirect supervision (jogging, treadmill, and sports). GII received the usual clinical treatment. RESULTS: The pre- and postobservation values in GI were, respectively: VO2peak (mL/kg/min), 24±5 and 31± 9; VO2 peak/peak HR: 0.18±0.05 and 0.28±0.13; peak double product (DP peak):26,800±7,000 and 29,000 ± 6,500; % peak HR/predicted HRmax: 89.5±9 and 89.3±9. The pre- and post- values in GII were: VO2 peak (mL/kg/min), 27± 7 and 28±5; VO2 peak/peak HR: 0.2±0.06 and 0.2± 0.05; DP peak: 24,900±8,000 and 25,600± 8,000, and % peak HR/predicted HRmax: 91.3±9 and 91.1± 11. The following values were significant: preobservation VO2peak versus postobservation VO2peak in GI (p=0.0 063); postobservation VO2peak in GI versus postobservation VO2peak in GII (p=0.0045); postobservation VO2 peak/peak HR GI versus postobservation peak VO2/peak HR in GII (p=0.0000). The follow-up periods in GI and GII were, respectively, 41.33± 20.19 months and 20.60±8.16 months (p<0.05). No difference between the groups was observed in coronary risk factors, therapeutic management, or evolution of ischemia. No cardiovascular events secondary to USR were observed in 620 patient-months. CONCLUSION: USR was safe and efficient, in low-risk patients with coronary artery disease and provided benefits at the peripheral level.

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