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Functional electrical stimulation (FES) produces beneficial effects in the treatment of patients with chronic heart failure (CHF), but studies carried out in these patients show small sample sizes and conflicting results. The aim of this meta-analysis was to systematically review the effect of treatment with FES compared with conventional aerobic exercise training (CA) or control group in patients with CHF. The search strategy included MEDLINE, LILACS, Physiotherapy Evidence Database and Cochrane Library. Randomized trials comparing FES versus CA or control group in the treatment of patients with CHF were included. Two reviewers independently extracted the data. Main analysis used a fixed-effects model. The search retrieved 794 articles, from which seven studies were included. Treatment with FES provided a smaller gain in peak VO2 compared with CA {-0.74 ml/kg per min [95% confidence interval (CI): -1.38 to -0.10]}. There was no difference in the muscle strength [-0.33 Nm (95% CI: -4.56 to 3.90)] and in the distance of the 6-min walk test [2.73 m (95% CI: -15.39 to 20.85)] on comparing FES with CA. An increase in peak VO2 of 2.78 ml/kg per min (95% CI: 1.44-4.13) was observed in FES versus the control group. Treatment with FES provides a similar gain in the distance of the 6-min walk test and in the muscle strength when compared with CA, but a small gain in the peak VO2. An increase in the peak VO2 can be obtained with FES as compared with the control group. Thus, FES may be an alternative in relation with CA for patients with CHF and with those who are unable to perform this kind of exercise.

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OBJECTIVES:The six-minute walk test has been widely used to evaluate functional capacity and predict mortality in several populations. Thus, the aim of this study was to evaluate the prognostic value of the six-minute walk test for the life expectancy of end-stage renal disease patients.METHODS:Patients over 18 years old who underwent hemodialysis for at least six months were included. Patients with hemodynamic instability, smoking, chronic obstructive pulmonary disease, physical incapacity and acute myocardial stroke in the preceding three months were excluded.RESULTS:Fifty-two patients (54% males; 36±11 years old) were followed for 144 months. The distance walked in the six-minute walk test was a survival predictor for end-stage renal disease patients. In the multivariate analysis, for each 100 meters walked with a 100-meter increment, the hazard ratio was 0.53, with a 95% confidence interval of 0.37-0.74. There was a positive correlation between the distance walked in the six-minute walk test and peak oxygen consumption (r = 0.508). In the multivariate analysis, each year of dialysis treatment represented a 10% increase in death probability; in the severity index analysis, each point on the scale represented an 11% increase in the death risk.CONCLUSIONS:We observed that survival increased approximately 5% for every 100 meters walked in the six-minute walk test, demonstrating that the test is a viable option for evaluating the functional capacity in patients with end-stage renal disease.

Introduction: High-intensity resistance exercises (RE) cause an inflammatory response that reduces functionality. Objective: To evaluate the effects of Cold Water Immersion (CWI) on leukocytosis, oxidative stress parameters, inflammatory markers and delayed onset muscle soreness (DOMS) resulting from a RE session in untrained volunteers. Methods: Thirteen volunteers (aged 26 ± 5 years) who do not engage in RE were randomized and underwent Control RE and RE with CWI sessions. Exercise sessions (leg extension machine, squats and leg presses) consisted of four sets of 10 maximum repetitions (one-week interval between the assessment and the sessions). CWI consisted of immersion in water (15°C) to the umbilicus for 10 minutes immediately after the exercise session. Complete blood count, CRP, creatine kinase (CK) and lipoperoxidation (LPO) were assessed previously (baseline) and immediately, 30 minutes and 2 hours after RE. DOMS was assessed 24 hours after the sessions. Results: RE induced progressive leukocytosis (P<0.001). CRP was elevated 2 hours after exercise (P=0.008) only in the Control RE session. CK increased 30 minutes and 2 hours after exercise (P<0.001) in the Control session, whereas in the CWI session the increase was observed after 2 hours (P<0.001). LPO increased only in the Control session after 2 hours (P=0.025). CWI reduced DOMS by 57% (P<0.001). Conclusion: CWI slows the inflammatory response and reduces DOMS in untrained individuals undergoing RE. Level of Evidence I; Randomized Clinical Trial.

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RESUMOObjetivo: Verificar a associação da força muscular respiratória com a capacidade funcional, força proximal de membros inferiores e variáveis bioquímicas em pacientes em hemodiálise (HD). Métodos: Participaram deste estudo 30 indivíduos (18 homens), com 53,4 ± 12,9 anos e tempo de HD de 41,1 ± 55,7 meses. Foram avaliados pressão inspiratória máxima (PImax), pressão expiratória máxima (PEmax), distância percorrida no teste de caminhada de seis minutos (6MWT), número de repetições no teste de sentar-e-levantar em 30 segundos (TSL) e registrados os exames bioquímicos de rotina no serviço. Resultados: Houve diminuição da PEmax em relação aos valores preditos (p = 0,015) e redução na distância percorrida no 6MWT quando comparados com equações de predição (p < 0,001). O logPImax e o logPEmax correlacionaram-se com o número de repetições no TSL (r = 0,476, p = 0,008; r = 0,540, p = 0,002, respectivamente), e com os níveis séricos de fósforo (r = 0,422, p = 0,020; r = 0,639, p < 0,001, respectivamente). A distância no 6MWT correlacionou-se com o logPEmax (r = 0,511; p = 0,004) e com o número de repetições no TSL (r = 0,561; p = 0,001). Conclusão: A redução da PEmax em pacientes com IRT em HD está associada à capacidade funcional, força proximal de membros inferiores e níveis de fósforo sérico, podendo representar, pelo menos em parte, o baixo desempenho físico-funcional desses pacientes.Palavras-chave: músculos respiratórios, insuficiência renal crônica, hemodiálise. ABSTRACTObjective: to evaluate the association of respiratory muscle strength with functional capacity, lower limb strength and biochemical variables in hemodialysis (HD) patients. Methods: a cross-sectional study involving 30 patients (18 male), 53.4 ± 12.9 years, 41.1 ± 55.7 months on HD therapy. Maximal inspiratory pressure (PImax), maximal expiratory pressure (PEmax), distance completed in a six-minute walk test (6MWT) and number of repetitions in sit-and-stand test (STST) were evaluated. The biochemical variables were recorded in the database routine work service. Results: LogEPmax and 6MWT values were significantly lower than the predicted values (p = 0.015; p < 0.001, respectively). logPImax and logPEmax were correlated with number of repetitions in STST (r = 0.476, p = 0.008; r = 0.540, p = 0.002, respectively) and with phosphorus blood levels (r = 0.422, p = 0.020; r = 0.639, p < 0.001, respectively). 6MWT was correlated with logPEmax (r = 0.511; p = 0.004) and with number of repetitions in STST (r = 0.561; p = 0.001). Conclusion: PEmax reduction in patients with ESRD on HD is associated with functional capacity, lower limb strength and phosphorus blood levels, and may at least partly represent the low physical and functional performance of these patients.

ABSTRACT. The present study aimed to investigate the interaction between the blood cells, inflammatory markers, oxidative stress parameters and delayed onset muscle soreness (DOMS) after a session of resistance exercise (SRE). The sample consisted of sixteen untrained men (26.4±5 years; 25.9±3 kg m -2 ). The SRE was composed of 4 sets of 10 repetitions maximum (extensor bench, squat and leg press) for each exercise. Complete blood cell count, C-reactive protein (CRP), creatine kinase (CK), lipid peroxidation and antioxidant capacity against peroxyl radicals were previously evaluated (baseline), and at 0, 30 and 120 min. after the SRE. DOMS was assessed 24 hours after the exercises. Immediately after the SRE, an increase of blood cell number was observed; returning to baseline after 30 min. However, after 120 min., neutrophils showed higher values than the baseline and 30 min. assessments. CK and CRP increased progressively throughout the experiment. LPO increased immediately and 120 min. after the SRE. Untrained volunteers presented an apparent biphasic inflammatory response after an acute SRE and the changes in oxidative stress, inflammatory markers and leukocytosis were best evidenced two hours after exercise.Keywords: exercise tolerance, pain, inflammation, oxidative stress.Resposta inflamatória após sessão de exercícios resistidos em voluntários destreinados RESUMO. O presente estudo investigou a interação entre as células sanguíneas, marcadores inflamatórios, parâmetros de estresse oxidativo e dor muscular de início tardio (DMIT) após uma sessão de exercícios de resistência (SER). A amostra compreendeu dezesseis voluntários destreinados (26.4±5 anos; 25.9±3 kg m -2 ). A SER consistiu em 4 séries de 10 repetições máximas (extensão do joelho, agachamento e leg press) para cada exercício. Hemograma completo, proteína C-reativa (PCR), creatina kinase (CK), lipoperoxidação e capacidade antioxidante contra o radical peroxil foram avaliados previamente (basal), 0, 30 e 120 min. após a SER. A DMIT foi avaliada 24h após os exercícios. Imediatamente após a SER ocorreu um aumento no número de células sanguíneas, retornando aos valores basais após 30 min. Entretanto, após 120 min. os neutrófilos apresentaram valores mais elevados que as avaliações basais e 30 min. A CK e a PCR aumentaram progressivamente ao longo do experimento. A liperoxidação aumentou imediatamente e 120 min. após a SER. Voluntários destreinados apresentam uma aparente resposta inflamatória bifásica após SER e as alterações dos parâmetros de estresse oxidativo, marcadores inflamatórios e leucocitose são melhor evidenciadas duas horas após os exercícios.Palavras-chave: tolerância aos exercícios, dor, inflamação, estresse oxidativo.