Transcutaneous electrical nerve stimulation and interferential current have similar effects on pain outcome The low number of studies included in this meta-analysis indicates that new clinical trials are needed.

Com a pandemia de COVID-19, é necessário o rápido entendimento das prováveis e graves sequelas que os pacientes sobreviventes podem desenvolver, assim como torna-se urgente traçar planos de ação para enfrentar tal situação desde o processo de alta hospitalar até a inserção em serviços de reabilitação cardiopulmonar. De acordo com recomendações internacionais, uma avaliação individualizada deve ser realizada e documentada no momento da alta, a qual deve contemplar as necessidades imediatas (controle dos sintomas como dispneia, fadiga e dor), assim como as necessidades a curto e médio prazo (melhora da função física e emocional; retorno ao trabalho; dentre outros). É aconselhável que nas primeiras semanas após a alta, o paciente seja atendido através de comunicação digital, a qual deve incluir imagem e áudio por questões de segurança. Componentes mandatórios dos programas de reabilitação cardiopulmonar incluem exercícios de força e resistência, além do trabalho da musculatura inspiratória. A abordagem educacional, é item importante no processo de tratamento. A reabilitação de doentes críticos acometidos por COVID-19 após alta hospitalar é de fundamental importância, especialmente naqueles que evoluíram com o quadro grave da doença, e que necessitaram de internação em UTI.

Objective The purpose of this study was to determine the effects of mat Pilates (MP) versus MP plus aerobic exercise (AE) compared with the effects of no intervention on ambulatory blood pressure (BP) in women with hypertension. Methods This 3-arm, parallel-group randomized clinical trial assessed 60 women who had hypertension and were 30 to 59 years old. The intervention lasted 16 weeks, and the participants were allocated into 3 groups: mat Pilates only (MP group), mat Pilates with alternating bouts of AE on a treadmill (MP + AE group), and control group (CG), with no exercises. Primary outcomes were the effects of the interventions on ambulatory BP assessed in the 24-hour, awake, and asleep periods of analysis. Results A 2-way analysis of variance did not reveal statistically significant differences in between-group comparisons in the 24-hour period of analysis for systolic BP (CG versus MP = 3.3 [95% CI = −7.1 to 13.8]; MP versus MP + AE = 0.7 [95% CI = −4 to 5.4]; CG versus MP + AE = 4.0 [95% CI = −5.2 to 13.4]), diastolic BP (CG versus MP = 2.2 [95% CI = −5.6 to 10.0]; MP versus MP + AE = 1.1 [95% CI = −4.3 to 6.5]; CG versus MP + AE = 3.3 [95% CI = −3.8 to 10.4]), and heart rate (CG versus MP = 3.4 [95% CI = −2 to 8.8]; MP versus MP + AE = 2.0 [95% CI = −3.4 to 7.5]; CG versus MP + AE = 5.4 [95% CI = −0.8 to 11.8]). The awake and asleep periods of analyses also showed similar behavior and did not reveal statistically significant between-group differences. Furthermore, in the responsiveness analysis based on the minimal clinically important difference, no differences were observed between groups. Conclusion The magnitudes of the decrease in systolic BP during the 24-hour period of analysis were − 3 and − 5.48 mm Hg for the MP and MP + AE groups, without differences for responsiveness between groups. The results suggest that MP supplemented with AE or not supplemented with AE may be an alternative adjuvant treatment for women who have hypertension and are using antihypertension medication. Impact. Sixteen weeks of MP training reduced ambulatory BP in women who had hypertension. The MP + AE group displayed a BP reduction similar to that of the MP group. A reduction in ambulatory BP can decrease the risk of cardiovascular disease.

Background: Cardiorespiratory limitation is a common hallmark of cardiovascular disease which is a key component of pharmacological and exercise treatments. More recently, inspiratory muscle training (IMT) is becoming an effective complementary treatment with positive effects on muscle strength and exercise capacity. We assessed the effectiveness of IMT on the cardiovascular system through autonomic function modulation via heart rate variability and arterial blood pressure. Methods: Randomized controlled trials (RCTs) were identified from searches of The Cochrane Library, MEDLINE and EMBASE to November 2018. Citations, conference proceedings and previous reviews were included without population restriction, comparing IMT intervention to no treatment, placebo or active control. Results: We identified 10 RCTs involving 267 subjects (mean age range 51–71 years). IMT programs targeted maximum inspiratory pressure (MIP) and cardiovascular outcomes, using low ( n =6) and moderate to high intensity ( n =4) protocols, but the protocols varied considerably (duration: 1–12 weeks, frequency: 3–14 times/week, time: 10–30 mins). An overall increase of the MIP (cmH 2 O) was observed (−27.57 95% CI −18.48, −37.45, I 2 =64%), according to weighted mean difference (95%CI), and was accompanied by a reduction of the low to high frequency ratio (−0.72 95% CI−1.40, −0.05, I 2 =50%). In a subgroup analysis, low- and moderate-intensity IMT treatment was associated with a reduction of the heart rate (HR) (−7.59 95% CI −13.96, −1.22 bpm, I 2 =0%) and diastolic blood pressure (DBP) (−8.29 [−11.64, −4.94 mmHg], I 2 =0%), respectively. Conclusion: IMT is an effective treatment for inspiratory muscle weakness in several populations and could be considered as a complementary treatment to improve the cardiovascular system, mainly HR and DBP. Further research is required to better understand the above findings.

patients with IMW+ had lower distance on the six-minute walk test in comparison to the IMW- group. The duration of highly active antiretroviral therapy, distance traveled on the 6MWT and CD4 count were determinants of IMW in patients with HIV.

BackgroundCoronary artery bypass graft (CABG) is a standard surgical option for patients with diffuse and significant arterial plaque. This procedure, however, is not free of postoperative complications, especially pulmonary and cognitive disorders.ObjectiveThis study aimed at comparing the impact of two different physiotherapy treatment approaches on pulmonary and cognitive function of patients undergoing CABG.MethodsNeuropsychological and pulmonary function tests were applied, prior to and following CABG, to 39 patients randomized into two groups as follows: Group 1 (control) – 20 patients underwent one physiotherapy session daily; and Group 2 (intensive physiotherapy) – 19 patients underwent three physiotherapy sessions daily during the recovery phase at the hospital. Non-paired and paired Student t tests were used to compare continuous variables. Variables without normal distribution were compared between groups by using Mann-Whitney test, and, within the same group at different times, by using Wilcoxon test. The chi-square test assessed differences of categorical variables. Statistical tests with a p value ≤ 0.05 were considered significant.ResultsChanges in pulmonary function were not significantly different between the groups. However, while Group 2 patients showed no decline in their neurocognitive function, Group 1 patients showed a decline in their cognitive functions (P ≤ 0.01).ConclusionThose results highlight the importance of physiotherapy after CABG and support the implementation of multiple sessions per day, providing patients with better psychosocial conditions and less morbidity.

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We aimed to investigate the effects of neuromuscular electrical stimulation on muscle strength, pain relief, and improvement in function in patients with knee osteoarthritis. Databases were searched from December 2017 to July 2020 and included PubMed, Embase, LILACS, and the Cochrane Central Register of Controlled Trials. A manual search was also performed by checking the reference lists of eligible articles. The PRISMA guidelines were followed. The studies selected compared NMES with an exercise program on isometric muscle strength as a primary outcome. The secondary outcomes were pain and function. The quality of the studies was assessed using the Risk of Bias assessment and PEDro scale, and the overall quality of the evidence was assessed using the GRADE approach. Eight studies were included in this systematic review. A total of 571 patients were analyzed. Neuromuscular electrical stimulation associated with exercise promoted an increase in isometric strength of the quadriceps muscle compared to the active control group, demonstrating heterogeneity and statistical difference (95% CI=1.16 to 5.10, I2=97%, p=0.002; very low-certainty evidence). NMES associated with exercise did not improve physical function (95% CI=−0.37 to 0.59, I2=0%, p=0.67; low-certainty evidence) and showed controversial results for pain compared to an active control group (qualitative assessment). In conclusion, NMES induces an increase in muscle strength in patients with osteoarthritis compared to an active control group. No differences were found for physical function and pain outcomes. Further research is needed due to the uncertain level of evidence.