Objective To analyze the published studies that investigated the physical function, activities of daily living and health-related quality of life in COVID-19 survivors. Design Systematic review. Methods We searched MEDLINE/PubMed, Scopus, SciELO, and Cochrane Library for studies that evaluated the physical function, activities of daily living and health-related quality of life after COVID-19 from the earliest date available to July 2021. Two independent reviewers screened and selected the studies. The Newcastle Ottawa Scale was used to evaluate methodological quality. Results We included 35 studies in this systematic review. Of the 35 studies included, 28 were cohort, and 7 cross-sectional studies The studies demonstrated that COVID-19 survivors had reduced levels of physical function, activities of daily living, and health-related quality of life. Furthermore, incomplete recovery of physical function, and performance in activities of daily living were observed 1 to 6 months post-infection. Discussion Physical disability and reduction in health-related quality of life is a common condition in post-COVID-19 and impairments may persist up to 1 to 6 months. Researchers and clinicians can use these findings to understand the potential disabilities and rehabilitation needs of people recovering from the COVID-19.
Introduction: The new corona virus (2019-nCoV OR HCOV-19 or CoV2), has emerged in China as the main cause of viral pneumonia (COVID-19, Coronavirus Disease-19). Objective: To provide evidence-based Physiotherapy and functionality in patients with adult and pediatric COVID-19. Methods: This is an integrative literature review using the MedLine / PubMed databases, library of Latin American and Caribbean Literature in Health Sciences (LILACS) and Physiotherapy Evidence Database (PEDRo). Results: Part of the patients with covid 19 show signs of respiratory deficiency with hypoxemia, with low severity in children. Impaired functionality is also expected. Conclusion: COVID-19 causes low pulmonary compliance and important changes in lung function with hypoxemia and cardiovascular repercussions. These changes lead to the need for Physiotherapy and the management of oxygen therapy and ventilatory support (invasive and non-invasive) for these patients.
Introdução: A respiração é uma atividade biomecânica complexa, que envolve o tronco e o esqueleto apendicular. Isso pode sugerir envolvimento dos músculos respiratórios como o diafragma na patomecânica do movimento humano. Objetivo: Revisar sistematicamente estudos observacionais sobre a influência do músculo diafragma no controle postural, propriocepção e dor lombar em indivíduos adultos com lombalgia e assintomáticos. Métodos: Revisão sistemática baseado nas recomendações PRISMA, realizada nas bases de dados: Ebisco, Lilacs, Medline, Pedro, Scopus, Pubmed e Scielo, até dezembro de 2018. Utilizaram-se os descritores: diaphragm, low back pain, proprioception e postural balance. Consideramos elegíveis: estudos observacionais, com adultos assintomáticos, ou, com dor lombar. Resultados: As buscas identificaram 230 estudos, contudo, apenas 11 foram incluídos. Os estudos avaliaram 421 sujeitos de ambos os sexos, com idade entre 18 e 71 anos. Em assintomáticos, a ativação do diafragma antecede os movimentos do tronco e esqueleto apendicular. Já na dor lombar, existe descoordenação diafragmática e respiratória, quando comparados aos voluntários assintomáticos. Também foi demostrada associação entre os músculos respiratórios e a propriocepção. Conclusão: Os resultados demonstram que o diafragma exerce influência na biomecânica da coluna, no controle postural, propriocepção e sua disfunção está associada a gênese da dor lombar.Palavras-chave: diafragma, propriocepção, dor lombar, controle postural.
INTRODUCTION: Although the reductive effect of a single physical exercise (PE) session on postprandial lipemia (PPL) is controversial, studies indicate that caloric expenditure is the main determinant of PPL reduction. OBJECTIVE: Test the hypothesis that a PE session based on caloric expenditure modifies PPL. METHODS: This is a prospective controlled intervention study, including a cohort of 18 men with average age of 22 ± 1.3 years and BMI of 21 ± 4.2 kg/m². All were irregularly active students, with fasting triglyceride (TG) values of less than or equal to 150mg/dL. They were submitted to two PPL tests: Basal (PPLB) and Exercise (PPLE). Blood samples were collected at time 0 (fasting) and after ingestion of a lipid compound (25g) at 180 and 240 minutes for TG dosing. In the PPLE test, a PE session on treadmill was applied shortly after the collection at 120 minutes, achieving an energy expenditure of 500kcal. STATISTICS: The medians of the variation (delta) between the TG values between fasting and 120min (Δ1), fasting and 240min (Δ2) and between 120 and 240min (Δ3) were compared. The bi-directional Wilcoxon test was used to compare deltas. RESULTS: The TG medians of Δ1 respectively for PPLB and PPLE were 63 Vs.60 (p=0.95); Δ2 102 Vs. 25 (p=0.02) and Δ3 32 Vs. -10 (p<0.01). CONCLUSION: In this study, a physical exercise session based on caloric expenditure of 500kcal, after lipid intake, reduced the PPL peak in healthy youngsters.
Exercícios funcionais e neuromusculares são importantes ferramentas em centros de reabilitação, porém são pouco explorados em protocolos hospitalares. objetivo: Verificar se exercícios funcionais e neuromusculares são mais eficazes na redução do tempo de internamento e controle da pressão arterial (PA) dos indivíduos hospitalizados do que a fisioterapia hospitalar de rotina. Métodos: Foram incluídos pacientes hospitalizados por enfermidades não cardiológicas e sem hipertensão arterial sistêmica, sendo estes randomizados para grupo controle (GC), que realizou exercícios respiratórios, exercícios ativo-livres para membros superiores/ inferiores e caminhada no corredor, ou grupo de reabilitação funcional (GRF), submetido a exercícios neuromusculares para membros superiores/inferiores, cicloergômetro e treino de subir/descer degraus. Ambos os grupos receberam intervenção 2x/dia. A PA foi aferida na admissão, durante o internamento e na alta hospitalar. O tratamento estatístico foi realizado adotando-se intervalo de confiança de 95% e nível de significância de 5%. resultados: Avaliados 42 voluntários, dos quais 26 atenderam aos critérios de elegibilidade. Porém, seis foram excluídos, quatro por permanência hospitalar inferior a três dias e dois por não completarem o protocolo de tratamento. A média de idade no GC foi de 72±11 versus 73±8 no GRF. Não houve diferenças estatísticas da PA na admissão. Evidenciou-se redução da PA apenas no GRF durante o internamento (p<0,01), assim como na alta hospitalar (p<0,01). O GC apresentou maior tempo (dias) de internação 7,2±1,8 versus 5,5±1,3 do GRF (p<0,05). Conclusão: Exercícios funcionais e neuromusculares parecem mais eficazes na redução do tempo de internamento e controle da PA dos indivíduos hospitalizados do que a fisioterapia hospitalar de rotina.Palavras-chave: serviço hospitalar de fisioterapia; pressão arterial; terapia por exercício; medicina física e reabilitação; tempo de internação. ABStrACt introduction:Functional and neuromuscular exercises are important tools in rehabilitation centers, however they are little explored in hospital protocols. objective: To determine whether functional and neuromuscular exercises are more effective in reducing hospital stay and controlling blood pressure (BP) of hospitalized individuals than routine hospital physiotherapy. Methods: Hospitalized patients for non-cardiac illnesses and without hypertension were included, which were randomized to the control group (CG), who performed breathing exercises, active-free exercises for upper/lower limbs and walk in the hallway, or to functional rehabilitation group (FRG), which underwent neuromuscular exercises for upper/lower limbs, cycle ergometer and up/down stairs training. Both groups received intervention 2x/day. BP was measured at admission, during hospitalization and at discharge. Statistical analysis was performed by adopting a confidence interval of 95% and a 5% significance level. results: Forty-two volunteers were evaluated, of which 26 met the eligibility criteria. However, six...
Although it is best known for damage to the respiratory system, today we know that the new coronavirus (COVID-19) can also compromise the heart [1]. This fact started to gain strength when a retrospective study pointed out that 33% of deaths in these cases were attributed to cardiorespiratory failure, and 7% to isolated heart failure [2].A report of a previously healthy woman who developed acute myopericarditis with systolic dysfunction during a COVID-19 condition, drew attention. In this case, it was possible to detect systemic inflammatory responses associated with markers of myocardial injury, such as elevated serum levels of highly sensitive troponin T and creatine kinase-MB. Furthermore, abnormalities in ventricular contraction were found, without any sign of obstruction of the acute coronary flow [3].Despite the strong evidence, there is still no proof of the presence of the virus within the myocardium, however the occurrence of direct and indirect cardiac lesions attributed to it is plausible. Indirect injuries can be caused by cardiac overload resulting from hypoxemic respiratory failure and systemic inflammation. Whereas direct lesions would be caused by successful tissue infection resulting in the death of cardiomyocytes [4].Another fact that suggests direct cardiac injury by COVID-19 was the presence of an inflammatory infiltrate of mononucleated cells found in autopsies in cardiac tissue [5]. In 2009, an outbreak caused by a variation of the coronavirus led researchers to investigate the presence of the viral genome in cardiac autopsies. Through the real-time polymerase chain reaction (qPCR), it was possible to find the genome in 35% of patients who died of acute respiratory syndrome [6]. This shows that it is possible to expect similar behavior in cases of COVID-19, as the genomes of both viruses are extremely similar [7].Previous knowledge states that viral respiratory infections can be the “trigger” for adverse effects of the heart [8]. In the case of arrhythmias, its manifestation can be observed in several ways, ranging from “simple” isolated premature ventricular contractions, to the successful ventricular fibrillation of asystole [9]. Regardless of the condition that generates arrhythmias, it is known that episodes of hypoxemia, sympathetic hyperactivity and pro-inflammatory effects, can make them more frequent [8,9].If in respiratory infections, healthy hearts can develop arrhythmias, what to expect from those with some affection already installed? The additional inflammation that is generated on the atheromatous plaque, together with the increased demand for oxygen and the reduction of its availability, increase the chances of myocardial infarction [10,11]. The clot formed in cases where the plaque ruptures limits the passage of blood, which causes ischemia and cardiac dysfunction [12].Still about ischemia, it is necessary to remember that pericytes are contractile, branched cells that have an important role in reducing the permeability of blood vessels [13]. Infectious conditions can promote lesions of these structures, thus causing ruptures of the microcirculation, with subsequent myocardial ischemia [4]. It is true that this process is still speculative, lacking studies that can confirm its hypothesis.The chances of heart failure decompensation in a COVID-19 infection are high. Its causes are also among those that trigger arrhythmias and infarction, especially myocarditis [8]. The risk of a heart with previous dysfunction deteriorating becomes greater when trying to compensate someone's respiratory system with all the consequences of a systemic inflammation [7]. Despite the relevance of decompensating heart failure, there is another scenario that is even more worrying.Retrospective cohorts have shown that signs of cardiac injury, such as increased levels of troponin at the onset of the disease, are associated with a worse prognosis [2,14]. In the study by Guo et al. [7] the direct relationship between troponin T and the levels of highly sensitive C-reactive protein (CRP) was proven, an important inflammatory marker that reinforces the link between inflammation and myocardial injury. This fact should not go unnoticed, as the risk of death in cases of myocardial injury exceeds that of factors such as age, presence of diabetes mellitus, previous chronic lung and heart disease [7,15].In short, the heart can be greatly affected in cases of COVID-19, contributing to a significant portion of cases of morbidity and mortality. The worst outcomes seem to be associated with those cases where the infectious process directly affects the heart, increasing the levels of troponin T and CRP. We must emphasize that there are several consequences, including arrhythmias, infarction and heart failure decompensation, triggered mainly by the exacerbated inflammatory response and myocarditis.
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