Efeitos de um programa de exercício físico combinado sobre a função cardíaca, capacidade funcional e qualidade de vida de pacientes com insuficiência cardíaca
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2020-02-14
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Universidade Estadual Paulista (Unesp)
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Fundamento: O arsenal terapêutico da insuficiência cardíaca (IC) consiste em diversas classes de medicamentos, utilização de marcapasso e cardiodesfibriladores implantáveis e reeducação alimentar. E são cada vez mais reconhecidos os benefícios do exercício físico (EF) na sobrevida, na qualidade de vida (QV), na capacidade funcional (CF), na inflamação, na função autonômica, no remodelamento cardíaco reverso e na função endotelial. A hipótese é a de que um programa de EF combinado (EFC), ou seja, EF aeróbico complementado por EF de força é capaz de promover melhora na função cardíaca global, e que esses efeitos estão associados ao aumento da CF e da QV desses pacientes. Objetivos: Verificar o efeito de um programa de EFC sobre as variáveis ecocardiográficas morfológicas e funcionais cardíacas; Avaliar a CF e a QV dos pacientes; Analisar a associação ou correlação entre as variáveis clínicas. Métodos: Ensaio clínico longitudinal, randomizado e controlado, composto por pacientes com IC com fração de ejeção reduzida (ICFER). Foram incluídos 82 voluntários divididos em dois grupos: Grupo Controle (GC n=41): receberam apenas recomendação médica de atividades físicas de rotina; Grupo Intervenção (GI n=41): submetidos a um programa de EFC e supervisionado, composto por exercício aeróbico do tipo caminhada contínua, acrescidos de EF de força, três vezes por semana durante 16 semanas. Ambos os grupos foram submetidos inicialmente e após 16 semanas de protocolo, aos seguintes procedimentos: teste de caminhada Cooper 12 minutos, questionários IPAQ e de QV (SF36), teste de preensão manual e ecocardiograma transtorácico. Resultados: Foram analisadas as participações no estudo de 82 voluntários (GC=41 e GI=41), pareados por idade e sexo. Não foram encontradas diferenças estatísticas entre as variáveis clínicas, terapia otimizada e de composição corporal entre os participantes. Houve melhora estatisticamente significante da QV no GI no momento pós em relação ao momento pré-treino em sete das oito dimensões reveladas pelo questionário de QV-SF36. Houve melhora significante no GI em relação ao GC em cinco das oito dimensões do questionário de QV-SF36. Em relação à CF houve melhora significante da distância percorrida e do VO2 de pico nos dois grupos no momento pós em relação ao momento pré-treino. Na comparação entre os grupos, o GI mostrou melhora significante em relação ao GC das variáveis de CF: distância percorrida (p<0,001); VO2 de pico (p<0,001) e Escore de Borg (p=0,002). Em relação à força de preensão manual houve melhora significante da força de preensão tanto na mão direita (p<0,001) como na mão esquerda (p=0,003) no GI no momento pós em relação ao momento pré-treino e melhora significante da força de preensão da mão direita no GI em relação ao GC (p<0,001). Sobre as variáveis ecocardiográficas, houve melhora significante no GI no momento pós em relação ao momento pré-treino nas variáveis morfológicas: diâmetro diastólico do ventrículo esquerdo (DDVE, p<0,001), diâmetro sistólico do ventrículo esquerdo (DSVE, p<0,001), espessura relativa da parede (ERP, p=0,039), índice de massa do ventrículo esquerdo (IMVE, p=0,01) e diâmetro do átrio esquerdo (AE, p<0,001); de função sistólica do VE: fração de encurtamento do VE (%deltaD, p<0,001), fração de ejeção do VE (FEs, p<0,001), velocidade de excursão sistólica do anel mitral ao Doppler tissular (Smédio, p<0,001) e débito cardíaco (DC, p<0,001) e de função diastólica do VE: volume do átrio esquerdo indexado (VAEi, p<0,001) e razão entre as ondas E de velocidade de fluxo transvalvar mitral na fase de enchimento ventricular rápido e e’ de velocidade de excursão diastólica do anel mitral ao Doppler tissular na fase de enchimento rápido (E/e’ médio, p=0,002). E quando comparado ao GC, o GI mostrou melhora significante das variáveis ecocardiográficas morfológicas: DDVE (p<0,001), DSVE (p<0,001), ERP (p=0,025) e AE (p<0,001); de função sistólica do VE: %deltaD (p<0,001), FEs (p<0,001), Smédio (p<0,001) e DC (p<0,001) e de função diastólica do VE: VAEi (p<0,001) e E/e'médio (p<0,001) ao final do protocolo. Conclusões: O presente estudo apresenta resultados, que corroboram a literatura atual e achados de relevância clínica, como a melhora das alterações morfofuncionais cardíacas. Dessa forma, o estudo evidencia a importância do programa de EFC supervisionado na reabilitação dos indivíduos em seguimento por IC.
Background: The therapeutic arsenal of heart failure (HF) consists of several classes of drugs, use of pacemakers and implantable cardiodesfibrillators, and nutritional education. And the benefits of physical exercise (PE) on survival, quality of life (QoL), functional capacity (FC), inflammation, autonomic function, reverse cardiac remodeling and endothelial function are increasingly recognized. The hypothesis is that a combined PE (CPE) program, ie, aerobic PE supplemented by strength PE, is capable of improving overall heart function and that these effects are associated with increased FC and QoL of these patients. Objectives: To verify the effect of a CPE program on cardiac morphological and functional echocardiographic variables; Evaluate the FC and QoL of the patients; Analyze the association or correlation between clinical variables. Methods: Longitudinal randomized controlled trial composed of patients with HF with reduced ejection fraction (HFrEF). Eighty-two volunteers were divided into two groups: Control Group (CG n = 41): received only medical recommendations for routine physical activities; Intervention Group (IG n = 41): undergoing a supervised CPE program, consisting of continuous walking type aerobic exercise, plus strength PE three times a week for 16-weeks. Both groups were initially submitted and after 16 weeks of protocol to the following procedures: 12-minute Cooper walk test, IPAQ and QoL questionnaires (SF36), handgrip test and transthoracic echocardiogram. Results: Participations in the study of 82 volunteers (CG = 41 and IG = 41), matched for age and gender, were analyzed. No statistical differences were found between clinical variables, optimized therapy and body composition among participants. There was a statistically significant improvement in QoL in the IG at the post-training moment compared to the pretraining moment in seven of the eight dimensions revealed by the QoL-SF36 questionnaire. There was a significant improvement in IG compared to CG in five of the eight dimensions of the QoL-SF36 questionnaire. Regarding FC, there was a significant improvement in the distance covered and peak VO2 in two groups in the post-relationship moment at the pre-training moment. In the comparison between the groups, the IG showed significant improvement in relation to the CG of the FC variables: distance traveled (p<0.001); peak VO2 (p<0.001) and Borg score (p=0.002). Regarding the handgrip strength, there was a significant increase in the grip strength in the right hand (p<0.001) as in the left hand (p=0.003) in the postrelationship IG at the pre-training moment and a significant improvement in the grip strength in the right hand in the IG compared to the CG (p<0.001). Regarding the echocardiographic variables, there was a significant improvement in IG at the post-training moment compared to the pre-training moment in the morphological variables: left ventricular diastolic diameter (LVDD, p<0.001), left ventricular systolic diameter (LVSD, p<0.001), relative wall thickness (RWT, p=0.039), left ventricular mass index (LVMI, p=0.01) and left atrial diameter (LA, p<0.001); of LV systolic function: LV shortening fraction (% deltaD, p<0.001), LV ejection fraction (EFs, p<0.001), mitral annulus systolic excursion velocity at tissue Doppler (Smean, p<0.001) and cardiac output (CO, p<0.001) and LV diastolic function: indexed left atrial volume (ILAV, p<0.001) and ratio of mitral transvalvular flow velocity E waves in the rapid ventricular filling phase and e’ of diastolic excursion velocity of the mitral annulus to tissue Doppler in the rapid filling phase (E/e’mean, p=0.002). And when compared to CG, the IG showed significant improvement in morphological echocardiographic variables: LVDD (p<0.001), LVSD (p<0.001), RWT (p=0.025) and LA (p<0.001); LV systolic function:% deltaD (p<0.001), EFs (p<0.001), Smean (p<0.001) and CO (p<0.001) and LV diastolic function: ILAV (p <0.001) and E/e'mean (p<0.001) at the end of the protocol. Conclusions: This study presents results that corroborate the current literature and findings of clinical relevance, such as improvements in cardiac morphofunctional changes. Thus, the study highlights the importance of the supervised CPE program in the rehabilitation of individuals undergoing HF.
Background: The therapeutic arsenal of heart failure (HF) consists of several classes of drugs, use of pacemakers and implantable cardiodesfibrillators, and nutritional education. And the benefits of physical exercise (PE) on survival, quality of life (QoL), functional capacity (FC), inflammation, autonomic function, reverse cardiac remodeling and endothelial function are increasingly recognized. The hypothesis is that a combined PE (CPE) program, ie, aerobic PE supplemented by strength PE, is capable of improving overall heart function and that these effects are associated with increased FC and QoL of these patients. Objectives: To verify the effect of a CPE program on cardiac morphological and functional echocardiographic variables; Evaluate the FC and QoL of the patients; Analyze the association or correlation between clinical variables. Methods: Longitudinal randomized controlled trial composed of patients with HF with reduced ejection fraction (HFrEF). Eighty-two volunteers were divided into two groups: Control Group (CG n = 41): received only medical recommendations for routine physical activities; Intervention Group (IG n = 41): undergoing a supervised CPE program, consisting of continuous walking type aerobic exercise, plus strength PE three times a week for 16-weeks. Both groups were initially submitted and after 16 weeks of protocol to the following procedures: 12-minute Cooper walk test, IPAQ and QoL questionnaires (SF36), handgrip test and transthoracic echocardiogram. Results: Participations in the study of 82 volunteers (CG = 41 and IG = 41), matched for age and gender, were analyzed. No statistical differences were found between clinical variables, optimized therapy and body composition among participants. There was a statistically significant improvement in QoL in the IG at the post-training moment compared to the pretraining moment in seven of the eight dimensions revealed by the QoL-SF36 questionnaire. There was a significant improvement in IG compared to CG in five of the eight dimensions of the QoL-SF36 questionnaire. Regarding FC, there was a significant improvement in the distance covered and peak VO2 in two groups in the post-relationship moment at the pre-training moment. In the comparison between the groups, the IG showed significant improvement in relation to the CG of the FC variables: distance traveled (p<0.001); peak VO2 (p<0.001) and Borg score (p=0.002). Regarding the handgrip strength, there was a significant increase in the grip strength in the right hand (p<0.001) as in the left hand (p=0.003) in the postrelationship IG at the pre-training moment and a significant improvement in the grip strength in the right hand in the IG compared to the CG (p<0.001). Regarding the echocardiographic variables, there was a significant improvement in IG at the post-training moment compared to the pre-training moment in the morphological variables: left ventricular diastolic diameter (LVDD, p<0.001), left ventricular systolic diameter (LVSD, p<0.001), relative wall thickness (RWT, p=0.039), left ventricular mass index (LVMI, p=0.01) and left atrial diameter (LA, p<0.001); of LV systolic function: LV shortening fraction (% deltaD, p<0.001), LV ejection fraction (EFs, p<0.001), mitral annulus systolic excursion velocity at tissue Doppler (Smean, p<0.001) and cardiac output (CO, p<0.001) and LV diastolic function: indexed left atrial volume (ILAV, p<0.001) and ratio of mitral transvalvular flow velocity E waves in the rapid ventricular filling phase and e’ of diastolic excursion velocity of the mitral annulus to tissue Doppler in the rapid filling phase (E/e’mean, p=0.002). And when compared to CG, the IG showed significant improvement in morphological echocardiographic variables: LVDD (p<0.001), LVSD (p<0.001), RWT (p=0.025) and LA (p<0.001); LV systolic function:% deltaD (p<0.001), EFs (p<0.001), Smean (p<0.001) and CO (p<0.001) and LV diastolic function: ILAV (p <0.001) and E/e'mean (p<0.001) at the end of the protocol. Conclusions: This study presents results that corroborate the current literature and findings of clinical relevance, such as improvements in cardiac morphofunctional changes. Thus, the study highlights the importance of the supervised CPE program in the rehabilitation of individuals undergoing HF.
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Palavras-chave
Insuficiência cardíaca, Ecocardiograma, Função ventricular, Exercício físico, Remodelação cardíaca, Heart failure, Echocardiogram, Ventricular function, Physical exercise, Cardiac remodeling