Veja reportagem sobre o tema desenvolvido neste artigo acessando o link: http://globotv.globo.com/tv-sergipe/se-tv-2a-edicao/v/games-sao-terapiapara-pacientes-cardiacos-em-aracaju/2194856/ EXPERIMENTAL STUDY Abstract Introduction: Cardiac surgery has been the intervention of choice in many cases of cardiovascular diseases. Susceptibility to postoperative complications, cardiac rehabilitation is indicated. Therapeutic resources, such as virtual reality has been helping the rehabilitational process. The aim of the study was to evaluate the use of virtual reality in the functional rehabilitation of patients in the postoperative period.Methods: Patients were randomized into two groups, Virtual Reality (VRG, n = 30) and Control (CG, n = 30). The response to treatment was assessed through the functional independence measure (FIM), by the 6-minute walk test (6MWT) and the Nottingham Health Profile (NHP). Evaluations were performed preoperatively and postoperatively.Results: On the first day after surgery, patients in both groups showed decreased functional performance. However, the VRG showed lower reduction (45.7±2.3) when compared to CG (35.06±2.09, P<0.05) in first postoperative day, and no significant difference in performance on discharge day (P>0.05). In evaluating the NHP field, we observed a significant decrease in pain score at third assessment (P<0.05). These patients also had a higher energy level in the first evaluation (P<0.05). There were no differences with statistical significance for emotional reactions, physical ability, and social interaction. The length of stay was significantly shorter in patients of VRG (9.4±0.5 days vs. 12.2 ± 0.9 days, P<0.05), which also had a higher 6MWD 282Rev Bras Cir Cardiovasc | Braz J Cardiovasc Surg Bras Cir Cardiovasc 2013;28(2):281-9 Rev

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Context: Cold-water immersion (CWI) has been applied widely as a recovery method, but little evidence is available to support its effectiveness.Objective: To investigate the effects of CWI on muscle damage, perceived muscle soreness, and muscle power recovery of the upper and lower limbs after jiu-jitsu training.Design: Crossover study. Setting: Laboratory and field. Patients or Other Participants: A total of 8 highly trained male athletes (age ¼ 24.0 6 3.6 years, mass ¼ 78.4 6 2.4 kg, percentage of body fat ¼ 13.1% 6 3.6%) completed all study phases.Intervention(s): We randomly selected half of the sample for recovery using CWI (6.08C 6 0.58C) for 19 minutes; the other participants were allocated to the control condition (passive recovery). Treatments were reversed in the second session (after 1 week).Main Outcome Measure(s): We measured serum levels of creatine phosphokinase, lactate dehydrogenase (LDH), aspartate aminotransferase, and alanine aminotransferase enzymes; perceived muscle soreness; and recovery through visual analogue scales and muscle power of the upper and lower limbs at pretraining, postrecovery, 24 hours, and 48 hours.Results: Athletes who underwent CWI showed better posttraining recovery measures because circulating LDH levels were lower at 24 hours postrecovery in the CWI condition (441.9 6 81.4 IU/L) than in the control condition (493.6 6 97.4 IU/L; P ¼ .03). Estimated muscle power was higher in the CWI than in the control condition for both upper limbs (757.9 6 125.1 W versus 695.9 6 56.1 W) and lower limbs (53.7 6 3.7 cm versus 35.5 6 8.2 cm; both P values ¼ .001). In addition, we observed less perceived muscle soreness (1.5 6 1.1 arbitrary units [au] versus 3.1 6 1.0 au; P ¼ .004) and higher perceived recovery (8.8 6 1.9 au versus 6.9 6 1.7 au; P ¼ .005) in the CWI than in the control condition at 24 hours postrecovery.Conclusions: Use of CWI can be beneficial to jiu-jitsu athletes because it reduces circulating LDH levels, results in less perceived muscle soreness, and helps muscle power recovery at 24 hours postrecovery.Key Words: creatine kinase, cryotherapy, L-lactate dehydrogenase, martial arts, muscle power Key PointsCold-water immersion may be beneficial to jiu-jitsu athletes because it decreased markers of muscle damage. Cold-water immersion reduced the perception of muscle pain. Cold-water immersion assisted in the recovery of the upper and lower limbs. Jiu-jitsu athletes could use cold-water immersion to improve performance and physiologic status, especially during training phases in which more intensive sessions are conducted and at the beginning of the season.

Background: Recovery from training is vital as it ensures training and performance to continue at high intensities and longer durations to stimulate the body and cause further adaptations. Objective: To evaluate different methods of post-workout recovery in Paralympic powerlifting athletes. Methods: Twelve male athletes participated (25.4 ± 3.3 years; 70.3 ± 12.1 kg). The presence of muscle edema, pain threshold, plasma cytokines, and performance measurement were evaluated five times. The recovery methods used in this study were passive recovery (PR), dry needling (DN), and cold-water immersion (CWI). Results: The data analysis showed that the maximal force decreased compared to the pretest value at 15 min and 2 h. The results also revealed that CWI and DN increased Interleukin 2 (IL-2) levels from 24 to 48 h more than that from 2 h to 24 h. After DN, muscle thickness did not increase significantly in any of the muscles, and after 2 h, muscle thickness decreased significantly again in the major pectoralis muscle. After CWI, pain pressure stabilized after 15 min and increased significantly again after 2 h for acromial pectoralis. Conclusion: The strength training sessions generate several changes in metabolism and different recovery methods contribute differently to maintain homeostasis in Paralympic powerlifting athletes.

Background:Early mobilization and physical exercise are considered fundamental components in cardiovascular surgery rehabilitation; however, occasionally they are inadequate for inhibiting functional decline. Neuromuscular electrical stimulation (NMES) is a promising tool in cardiovascular rehabilitation; however, to date, no randomized clinical trial has measured the effects of NMES on functional capacity and quality of life in patients who undergo routine cardiac surgery with a short intensive care unit (ICU) stay. Therefore, we aimed to investigate the effects of NMES on walking ability, muscle strength, functional independence, and quality of life in cardiac valve surgery patients in the immediate postoperative period.Methods:A randomized, parallel, controlled, 2-arm clinical trial with assessor blinding was conducted. Fifty-nine adult patients in the preoperative period after cardiac valve reconstruction and/or replacement were randomly assigned to a control or intervention group. The intervention group underwent NMES in the quadriceps and gastrocnemius, bilaterally, for 60 minutes, for up to 10 sessions. The primary outcome was ambulation ability, assessed through the Six-Minute Walk Test and Walking Speed Test at postoperative day 5 (5PO). Secondary outcomes were muscular strength (assessed through the Medical Research Council scale), functional independence measure (assessed through the Functional Independence Measurement Questionnaire), and quality of life (assessed through the Nottingham Health Profile) at baseline (preoperative) and at postoperative days 3 and 5.Results:The baseline characteristics were similar in both groups, except for body mass index. There was no statistically significant difference, with a small effect size, between both groups regarding the distance walked (95% CI, −64.87 to 65.97) and walking speed (95% CI, −0.55 to 0.57). There was a statistically significant difference in upper-limb muscle strength loss and decline in mobility at postoperative day 3, which had a tendency to recover to initial values at 5PO, in both groups. No significant between-group difference was noted for muscle strength, functional independence, and quality of life.Conclusions:The use of NMES had no effect on walking ability, strength, quality of life, or functional outcome in the postoperative period for patients that underwent regular valve replacement.

IntroductionThe aim of this study was to identify the determinants of distance walked in six-minute walk test (6MWD) in patients undergoing cardiac surgery at hospital discharge.MethodsThe assessment was performed preoperatively and at discharge. Data from patient records were collected and measurement of the Functional Independence Measure (FIM) and the Nottingham Health Profile (NHP) were performed. The six-minute walk test (6MWT) was performed at discharge. Patients undergoing elective cardiac surgery, coronary artery bypass grafting or valve replacement were eligible. Patients older than 75 years who presented arrhythmia during the protocol, with psychiatric disorders, muscular or neurological disorders were excluded from the study.ResultsSixty patients (44.26% male, mean age 51.53 ± 13 years) were assessed. In multivariate analysis the following variables were selected: type of surgery (P = 0.001), duration of cardiopulmonary bypass (CPB) (P = 0.001), Functional Independence Measure - FIM (0.004) and body mass index - BMI (0.007) with r = 0.91 and r2 = 0.83 with P < 0.001. The equation derived from multivariate analysis: 6MWD = Surgery (89.42) + CPB (1.60) + MIF (2.79 ) - BMI (7.53) - 127.90.ConclusionIn this study, the determinants of 6MWD in patients undergoing cardiac surgery were: the type of surgery, CPB time, functional capacity and body mass index.

O presente estudo comparou a função pulmonar e a fadiga de mulheres antes e após a radioterapia (RT) adjuvante para tratamento do câncer de mama, e correlacionou a função pulmonar com a dose de radiação e fadiga. Foi conduzido um estudo observacional longitudinal envolvendo 20 mulheres. A função pulmonar foi avaliada pela espirometria (ClementClarke®) e manovacuometria (GlobalMed®, modelo MVD 300), e a fadiga pelo Functional Assessment of Cancer Therapy Fatigue (FACT-F). Todas as avaliações foram realizadas antes da primeira sessão e uma semana após o término da RT adjuvante. Para a análise estatística foram utilizados os testes Wilcoxon Signed Rank Test e correlação de Spearman, adotando-se nível de significância p<0,05. Na espirometria, encontrou-se redução significativa da capacidade vital forçada (23,52%), do volume expiratório forçado no primeiro segundo (26,23%) e do pico de fluxo expiratório (10,12%) (p=0,001). As pressões expiratórias e inspiratórias máximas também diminuíram significativamente (25,45 e 32,92%, respectivamente). Observou-se diminuição significativa do bem-estar físico e do bem-estar funcional, e um aumento significativo da fadiga no FACT-F (p=0,001). Não foram observadas correlações entre as variáveis da função pulmonar com a dose de radiação e fadiga. Em curto prazo, a RT promoveu redução na função pulmonar, mas a mesma permaneceu próxima à normalidade para a amostra estudada. Observou-se aumento significativo da fadiga e diminuição dos escores dos domínios bem-estar físico e funcional.

Background: Neuromuscular electrical stimulation seems to be a promising option to intensify the rehabilitation and improve the exercise capacity of patients in the immediate postoperative period of cardiac surgery.Objective: This study aimed to evaluate the hemodynamic (heart rate, systolic blood pressure, diastolic blood pressure, and mean blood pressure) and respiratory (respiratory rate and oxygen saturation) responses to neuromuscular electrical stimulation in the immediate postoperative period in patients submitted to cardiac surgery and to verify its feasibility and safety.Methods: This is a pilot randomized controlled trial, wherein critical patients in the immediate postoperative period of cardiac surgery were randomly assigned to a control group, using sham neuromuscular electrical stimulation, or an experimental group, submitted to neuromuscular electrical stimulation sessions (FES), for 60 min, with a 50-Hz frequency, 200-μs pulse duration, time on: 3 s, and time off: 9 s. Data distribution was evaluated by the Shapiro-Wilk test. The analysis of variance was used and a p-value < 0.05 was considered significant.Results: Thirty patients were included in the study. The neuromuscular electrical stimulation was applied within the first 23.13 ± 5.24 h after cardiac surgery, and no changes were found regarding the hemodynamic and respiratory variables between the patients who underwent neuromuscular electrical stimulation, and those in the control group. Conclusions:In the present study, neuromuscular electrical stimulation did not promote changes in hemodynamic and respiratory responses of patients in the immediate postoperative period of cardiac surgery.