Home-based IMT represents an important strategy to improve cardiac and peripheral autonomic controls, functional capacity, and quality of life in patients with CHF.

IMT demonstrates beneficial effects on systolic and diastolic blood pressure as well as autonomic cardiovascular control in hypertensive patients.

Background Aortic stenosis is a valvular heart disease characterised by fixed obstruction of the left ventricular outflow. It can be managed by surgical aortic valve replacement (sAVR) or transcatheter aortic valve implantation (TAVI). This review aimed to describe the evidence supporting a cardiac rehabilitation programme on functional capacity and quality of life in aortic stenosis patients after sAVR or TAVI. Methods The search was conducted on multiple databases from January to March 2016. All studies were eligible that evaluated the effects of a post-interventional cardiac rehabilitation programme in aortic stenosis patients. The methodological quality was assessed using the PEDro scale. Meta-analysis was performed separately by procedure and between procedures. The walked distance during the six-minute walk test (6MWD) and Barthel index were evaluated. The analysis was conducted in Review Manager. Results Five studies were included (292 TAVI and 570 sAVR patients). The meta-analysis showed that a cardiac rehabilitation programme was associated with a significant improvement in 6MWD (0.69 (0.47, 0.91); P < 0.001) and Barthel index (0.80 (0.29, 1.30); P = 0.002) after TAVI and 6MWD (0.79 (0.43, 1.15); P < 0.001) and Barthel index (0.93 (0.67, 1.18); P < 0.001) after sAVR. In addition, the meta-analysis showed that the cardiac rehabilitation programme promoted a similar gain in 6MWD (4.28% (-12.73, 21.29); P = 0.62) and Barthel index (-1.52 points (-4.81, 1.76); P = 0.36) after sAVR or TAVI. Conclusions The cardiac rehabilitation programme improved the functional capacity and quality of life in aortic stenosis patients. Patients who underwent TAVI benefitted with a cardiac rehabilitation programme similar to sAVR patients.

OBJECTIVE:The aim of the present study was to evaluate the effect of 8 weeks of aerobic exercise training on cardiac functioning and remodeling and on the plasma levels of inflammatory cytokines in chronic heart failure rats.METHODS:Wistar rats were subjected to myocardial infarction or sham surgery and assigned to 4 groups: chronic heart failure trained (n = 7), chronic heart failure sedentary (n = 6), sham trained (n = 8) and sham sedentary (n = 8). Four weeks after the surgical procedures, the rats were subjected to aerobic training in the form of treadmill running (50 min/day, 5 times per week, 16 m/min). At the end of 8 weeks, the rats were placed under anesthesia, the hemodynamic variables were recorded and blood samples were collected. Cardiac hypertrophy was evaluated using the left ventricular weight/body weight ratio, and the collagen volume fraction was assessed using histology.RESULTS:The chronic heart failure trained group showed a reduction in left ventricular end-diastolic pressure, a lower left ventricular weight/body weight ratio and a lower collagen volume fraction compared with the chronic heart failure sedentary group. In addition, exercise training reduced the plasma levels of TNF-α and IL-6 and increased the plasma level of IL-10.CONCLUSION:An 8-week aerobic exercise training program improved the inflammatory profile and cardiac function and attenuated cardiac remodeling in chronic heart failure rats.

Jaenisch RB, Hentschke VS, Quagliotto E, Cavinato PR, Schmeing LA, Xavier LL, Dal Lago P. Respiratory muscle training improves hemodynamics, autonomic function, baroreceptor sensitivity, and respiratory mechanics in rats with heart failure. J Appl Physiol 111: 1664 -1670, 2011. First published September 8, 2011 doi:10.1152/japplphysiol.01245.2010.-Respiratory muscle training (RMT) improves functional capacity in chronic heart-failure (HF) patients, but the basis for this improvement remains unclear. We evaluate the effects of RMT on the hemodynamic and autonomic function, arterial baroreflex sensitivity (BRS), and respiratory mechanics in rats with HF. Rats were assigned to one of four groups: sedentary sham (n ϭ 8), trained sham (n ϭ 8), sedentary HF (n ϭ 8), or trained HF (n ϭ 8). Trained animals underwent a RMT protocol (30 min/day, 5 day/wk, 6 wk of breathing through a resistor), whereas sedentary animals did not. In HF rats, RMT had significant effects on several parameters. It reduced left ventricular (LV) end-diastolic pressure (P Ͻ 0.01), increased LV systolic pressure (P Ͻ 0.01), and reduced right ventricular hypertrophy (P Ͻ 0.01) and pulmonary (P Ͻ 0.001) and hepatic (P Ͻ 0.001) congestion. It also decreased resting heart rate (HR; P Ͻ 0.05), indicating a decrease in the sympathetic and an increase in the vagal modulation of HR. There was also an increase in baroreflex gain (P Ͻ 0.05). The respiratory system resistance was reduced (P Ͻ 0.001), which was associated with the reduction in tissue resistance after RMT (P Ͻ 0.01). The respiratory system and tissue elastance (Est) were also reduced by RMT (P Ͻ 0.01 and P Ͻ 0.05, respectively). Additionally, the quasistatic Est was reduced after RMT (P Ͻ 0.01). These findings show that a 6-wk RMT protocol in HF rats promotes an improvement in hemodynamic function, sympathetic and vagal heart modulation, arterial BRS, and respiratory mechanics, all of which are benefits associated with improvements in cardiopulmonary interaction. myocardial infarction; cardiovascular control; diaphragm; cardiopulmonary interaction THE HALLMARK SYMPTOMS OF heart failure (HF) subsequent to myocardial infarction (MI) are dyspnea and early fatigue, leading to reduced exercise tolerance and functional capacity (1). Furthermore, after MI, the neurohumoral excitation, which initially helps to preserve the cardiac output of patients who have systolic dysfunction, becomes deleterious with the persistence of cardiac dysfunction (12). In HF, the neurohumoral excitation is characterized by sympathetic hyperactivity and the attenuation of parasympathetic activity (12), which is associated with blunted baroreflex sensitivity (BRS) (30). In this context, impaired short-term control of arterial pressure (AP) and decreased heart-rate variability (HRV) (30) have been associated with an increased risk of sudden death of cardiac origin (45) and postinfarct mortality, regardless of the ejection fraction or ventricular arrhythmias (30).Together with the cardiovascular alterations, changes in the r...

Previous studies have proposed only one prediction equation for respiratory muscle strength without taking into consideration differences between ages in pediatric population. In addition, those researches were single-center studies. The objective of this study was to establish reference equations for maximal inspiratory pressure (PImax) and maximal expiratory pressure (PEmax) in children and teenagers. In a multicenter study, 450 healthy volunteers were evaluated (aged 6–18yrs). There were included volunteers with normal lung function. We excluded volunteers who could not perform the tests; participated in physical activity more than twice a week; were born prematurely; smokers; chronic respiratory, cardiologic, and/or neurologic diseases; had acute respiratory disease during the prior three weeks. The volunteers were divided into two groups: Group 6–11 (6–11yrs) and Group 12–18 (12–18yrs). PImax and PEmax were measured according to statement. The mean PImax value was 85.6 (95%IC 83.6–87.6 cmH2O), and PEmax 84.6 (95%IC 85.5–86.2 cmH2O). The prediction equations for PImax and PEmax for Group 6–11 were 37.458–0.559 + (age * 3.253) + (BMI * 0.843) + (age * gender * 0.985); and 38.556 + 15.892 + (age * 3.023) + (BMI * 0.579) + (age * gender * 0.881), respectively (R2 = 0.34 and 0.31, P<0.001). The equations for Group 12–18 were 92.472 + (gender * 9.894) + 7.103, (R2 = 0.27, P = 0.006) for PImax; and 68.113 + (gender * 17.022) + 6.46 + (BMI * 0.927), (R2 = 0.34, P<0.0001) for PEmax. This multicenter study determined the respiratory muscle strength prediction equations for children and teenagers.

Sympathetic and parasympathetic nervous system imbalance has been strongly associated to sudden cardiac death. Among the non-pharmacological treatment, transcutaneous electrical nerve stimulation (TENS) represents a possible therapeutic intervention to reduce sympathetic excitation and improve the sympatho-vagal balance in different clinical conditions. We aimed to verify acute effects of high and low transcutaneous electrical nerve stimulation (TENS) frequencies by the evaluation of heart rate variability. Seven healthy volunteers received an application of low frequency (10-Hz) and high frequency (100-Hz) TENS. After 10-Hz, there was decrease of LF normalized units (n.u.) component (32.7±5.9 vs 18.3±3.4, p<0.002) and increase of HF n.u. (60.9±4.3 vs 72.6±8.9, p<0.016). In contrast, after 100-Hz there was increase of LF n.u. (31.5±16.1 vs 41.6±12.2, p<0.019) and reduction of HF n.u. (63.9±15.3 vs 53.7±12.3, p<0.031). In conclusion, TENS modulates sympathetic and parasympathetic activity in a frequency dependent manner.

| 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.Keywords: physical therapy; diabetic neuropathies; electrical stimulation; electromagnetic fields; pain; review. HOW TO CITE THIS ARTICLE