We assessed the 6-min walk distance (6MWD) and body weight x distance product (6MWw) in healthy Brazilian subjects and compared measured 6MWD with values predicted in five reference equations developed for other populations. Anthropometry, spirometry, reported physical activity, and two walk tests in a 30-m corridor were evaluated in 134 subjects (73 females, 13-84 years). Mean 6MWD and 6MWw were significantly greater in males than in females (622 ± 80 m, 46,322 ± 10,539 kg . m vs 551 ± 71 m, 36,356 ± 8,289 kg . m, P < 0.05). Four equations significantly overestimated measured 6MWD (range, 32 ± 71 to 137 ± 74 m; P < 0.001), and one significantly underestimated it (-36 ± 86 m; P < 0.001). 6MWD significantly correlated with age (r = -0.39), height (r = 0.44), body mass index (r = -0.24), and reported physical activity (r = 0.25). 6MWw significantly correlated with age (r = -0.21), height (r = 0.66) and reported physical activity (r = 0.25). The reference equation devised for walk distance was 6MWD m = 622.461 -(1.846 x Age years ) + (61.503 x Gender males = 1; females = 0 ); r 2 = 0.300. In an additional group of 85 subjects prospectively studied, the difference between measured and the 6MWD predicted with the equation proposed here was not significant (-3 ± 68 m; P = 0.938). The measured 6MWD represented 99.6 ± 11.9% of the predicted value. We conclude that 6MWD and 6MWw variances were adequately explained by demographic and anthropometric attributes. This reference equation is probably most appropriate for evaluating the exercise capacity of Brazilian patients with chronic diseases.

BACKGROUND: Chronic heart failure is commonly associated with inspiratory muscle weakness. However, few studies have investigated the risk factors for inspiratory muscle weakness in individuals with chronic heart failure and systolic dysfunction (left-ventricular ejection fraction [LVEF] <40%). METHODS: Seventy subjects were recruited in a cardiac center. We assessed clinical parameters, smoking history, peripheral muscle strength, pulmonary function, echocardiographic variables, and brain natriuretic peptide. The subjects were classified with inspiratory muscle weakness when the maximum inspiratory pressure was <70% of predicted values. RESULTS: Thirty-six subjects (51%) had inspiratory muscle weakness. The subjects with inspiratory muscle weakness and the subjects with no inspiratory muscle weakness were similar in age, sex, body mass index, medication use, and physical activity. However, the subjects with inspiratory muscle weakness had lower LVEF (P ‫؍‬ .003), systolic blood pressure (P ‫؍‬ .01), diastolic blood pressure (P ‫؍‬ .042), quadriceps muscle strength (P ‫؍‬ .02), lung function (P ‫؍‬ .035), increased brain natriuretic peptide (P ‫؍‬ .02), smoking history (P ‫؍‬ .01), and pulmonary hypertension incidence (P ‫؍‬ .03). Multivariate logistic regression analysis found a lower LVEF, increased smoking history, and lower systolic blood pressure as significant independent predictors for inspiratory muscle weakness. CONCLUSIONS: The combination of lower LVEF, lower systolic blood pressure, and smoking history predicted inspiratory muscle weakness. Patients with suspected inspiratory muscle weakness should be examined and, if inspiratory muscle weakness exists, then inspiratory muscle training should be provided. Reducing inspiratory muscle weakness has the potential to improve many of the deleterious effects of chronic heart failure.

OBJETIVO: Fazer uma revisão bibliográfica a respeito dos efeitos dos principais recursos eletrofísicos utilizados na aceleração do metabolismo ósseo e no tratamento da osteoporose. ANTECEDENTES: A Organização Mundial da Saúde (OMS) define a osteoporose como doença esquelética sistêmica caracterizada por diminuição da massa óssea e deterioração microarquitetural do tecido ósseo, com consequente aumento da fragilidade óssea e susceptibilidade à fratura. Vários tratamentos medicamentosos e não medicamentosos vêm sendo desenvolvidos na tentativa de aumentar a massa óssea e prevenir a osteoporose. Dentro desse contexto, os recursos eletrofísicos vêm tendo um papel de destaque, como recursos que apresentam um potencial osteogênico, capazes de estimular a proliferação de osteoblastos e biomodular o metabolismo ósseo. ESTRATÉGIA DE PESQUISA: Foram consultadas as bases de dados: The Cochrane Library, MEDLINE, Embase, LILACS, SciELO, referências dos artigos identificados, e contato com especialisas em laser, entre os anos de 1983 e 2009. CRITÉRIOS DE SELEÇÃO: Foram incluídos estudos experimentais e ensaios clínicos randomizados que avaliaram os efeitos dos recursos eletrofísicos na osteoporose. RECOMPILAÇÃO E ANÁLISE DE DADOS: Dois revisores selecionaram independentemente os estudos, avaliaram sua qualidade metodológica dos estudos e coletaram os dados. RESULTADOS: Todos os recursos eletrofísicos citados neste artigo se mostraram eficazes na estimulação do metabolismo ósseo. No entanto, a grande maioria dos estudos realizados evidenciam esses efeitos através de estudos in vitro e estudos experimentais com cobaias. Cabe ressaltar que trabalhos como esses são raros em seres humanos. Baseado nos achados desta revisão pode ser sugerido que os recursos eletrofísicios como o laser terapêutico, o ultrassom, campos eletromagnéticos e plataformas vibratórias são recursos que tem um potencial osteogênico entretanto mais estudos são necessários para definir os efeitos dos mesmos em humanos, bem como, protocolos mais eficazes de tratamento. CONCLUSÃO: A partir deste levantamento bibliográfico, fica evidente que os recursos eletrofísicos apresentam um grande potencial osteogênico, porém, a maior parte dos estudos é in vitro. São necessários mais estudos in vivo, definindo, assim, melhores parâmetros e doses, para que sejam utilizados no tratamento da osteoporose.

OBJECTIVES: We aimed to compare the effects of home-and center-based exercise training programs on functional capacity, inspiratory muscle strength, daily physical activity level, and quality of life (QoL) in patients with chronic heart failure (CHF) over a 12-week period. METHODS: This study included 23 patients with CHF (left ventricular ejection fraction 31±6%) randomized to a home-based (n=11) or center-based (n=12) program. Patients underwent 12 weeks of aerobic training (60%-70% heart rate reserve): walking for the home-based and supervised cycling for the center-based group, both combined with resistance training (50% of 1 maximum repetition). At baseline and after 12 weeks of training, we assessed cardiopulmonary test variables, 6-min walk test distance (6 MWD), steps/day with accelerometry, and QoL (Minnesota Living with Heart Failure questionnaire). Maximal inspiratory pressure and handgrip strength were measured at baseline and after 4, 8, and 12 weeks of training. ClinicalTrials.gov: NCT03615157. RESULTS: There were no adverse events during training in either group. The home- and center-based training groups obtained similar improvements in peak oxygen uptake, maximal ventilation, and 6 MWD. However, there were significant between-group differences: center-based training was more effective in improving maximal inspiratory pressure ( p =0.042), number of steps/day ( p =0.001), and QoL ( p =0.039). CONCLUSIONS: Home-based training is safe and can be an alternative to improve the exercise capacity of patients with stable CHF. However, center-based training was superior in improving inspiratory muscle strength, QoL, and daily physical activity.

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The Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) is a simple, feasible, and sensitive questionnaire developed in English for assessing the health status (symptoms, function, and quality of life) of patients with heart failure (HF). We aimed to assess the internal consistency and construct validity of the Portuguese version of KCCQ-12. We administered the KCCQ-12, the Minnesota Living Heart Failure (MLHFQ), and the New York Heart Association (NYHA) classification by telephone. Internal consistency was assessed with Cronbach’s Alpha (α-Cronbach) and construct validity with correlations to the MLHFQ and NYHA. Internal consistency was high (α-Cronbach = 0.92 for the Overall Summary score and 0.77–0.85 for the subdomains). Construct validity was supported by finding high correlations between the KCCQ-12 Physical Limitation and the Symptom Frequency domains with the physical domain of the MLHFQ (r = −0.70 and r = −0.76, p < 0.001 for both) and the Overall Summary scale with NYHA classifications (r = −0.72, p < 0.001). The Portuguese version of KCCQ-12 has high internal consistency and shows a convergent construct validity with other measures quantifying the health status of patients with chronic HF and can be used confidently in Brazil for research and clinical care.

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