Cardiovascular and Metabolic Effects of Treadmill Gait Training Associated With Functional Electrical Stimulation in Individuals Post-brain Vascular Accident

Introduction: Stroke is one of the major causes of morbidity/mortality in the world and affected individuals, due to important (mainly motor) impairments, have their physical capacity to exercise reduced, a fact that aggravates the cardiovascular risk factors already installed. For this reason, a cardiovascular rehabilitation program, in addition to motor rehabilitation, must be added to the life of this individual. Objective: To verify the cardiovascular and metabolic effects of treadmill gait training associated with functional electrical stimulation in individuals after stroke. Method: This study will be an analysis based on archived data from the project "Functional electrical stimulation during gait training in people after stroke" approved by the CEP with CAAE number: 52079115.4.0000.5515. Such analyzes have not been carried out before and they will enable the discussion of other important points for the scientific community and health professionals. The study included 20 adults (aged between 45 and 59 years) and elderly individuals (aged between 60 and 70 years) with sequelae of hemiparesis due to stroke, of both sexes. To assess functional capacity, the 6-minute walk test was performed and, from this, the Double product, VO2max and metabolic consumption units (METs) will be estimated in this research. There were two protocols (Group A and B) formed by two training phases alternating between moments with and without electrical stimulation (WalkAide), consisting of 12 sessions, twice a week and lasting 30 minutes. In each session before and after training, the participants remained seated at rest for 10 minutes, for the collection of cardiorespiratory parameters and heart rate variability. During training on a treadmill with or without electrical stimulation, heart rate and heart rate variability (HRV) were monitored, and a detailed analysis of HRV will be carried out in this research. Data will be analyzed and statistically treated, considering a significance level of p<0.05.

开始日期2022-08-20

申办/合作机构

University of Sao Paulo

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2025-03-01·Computer Methods and Programs in Biomedicine

M-health with cardiac rehabilitation improves functional capacity: A systematic review with meta-analysis

Review

作者: de Abreu, Marilda Aparecida Milanez Morgado ; Toledo, Ana Clara Campagnolo Gonçalves ; Milanez, Vinicíus Flávio ; Kretli Winkelströter, Lizziane ; Pierucci, Alessandro ; Nakagaki, Wilson Romero ; de Almeida, Nathália Soares ; Lemes, Ítalo Ribeiro ; Oliveira, Crystian Bitencourt

BACKGROUND AND OBJECTIVEIn this systematic review and meta-analysis, we compared the effectiveness of the combined m-health and a cardiac rehabilitation program (CRP) and of CRP alone on functional capacity, adherence to CRP, and management of cardiovascular risk factors in cardiac patients.METHODSMedline, EMBASE, Central, PEDro, and SPORTDiscus were searched, from inception until July 2020, for randomized controlled trials (RCTs) comparing the m-health with CRP combination with CRP alone for adults with heart disease. The PEDro scale and GRADE approach was used to assess methodological and overall quality, respectively. Pooled estimates were calculated using a random-effects model to obtain the mean difference (MD) or standardized mean difference (SMD), and their respective 95 % confidence intervals (95 %CIs).RESULTSTwenty-two RCTs were eligible. The median risk-of-bias was 6.5/10. CRP with the m-Health intervention was more effective than CRP alone in improving VO₂peak (MD: 1.02 95 %CI 0.50 -1.54) at short-term, and at medium-term follow-up (MD: 0.97, 95 %CI: 0.04 - 1.90. Similarly, CRP and m-Health were superior to CRP alone in increasing self-reported physical activity at short-term (SMD: 0.98, 95 %CI: 0.65 - 1.32] but not at medium-term follow-up (SMD: 0.18, 95 %CI:0.01 to 0.36). Furthermore, supervision of CRP with the m-Health intervention at short-term follow-up and M-Health and semi-supervised CRP - medium-term were more effective in improving VO₂peak respectively (MD: 1.01, 95 %CI: 0.38‒1.64), (MD: 1.49, 95 %CI: 0.09, 2.89), and self-reported physical activity than supervised CRP at short-term (SMD: 0.98, 95 %CI: 0.65‒1.32) medium-term follow-ups (MD: 0.29 95 %CI: 0.12, 0.45].CONCLUSIONOur review found high-quality evidence that m-health interventions combined with CRP was more effective than CRP alone in improving cardiorespiratory fitness, at the short and medium terms follow-up.

2025-01-01·Journal of Clinical Epidemiology

Article

作者: Hartvigsen, Jan ; Halsnes, Einar Henjum ; Kjønø, Lise Grethe ; Ostelo, Raymond ; Grotle, Margreth ; Yvernay, Louis ; Vidal, Rubens ; Killingmo, Rikke Munk ; Enstad, Christian Lindtveit ; Johnsen, Marianne Bakke ; Oliveira, Crystian B ; Grande, Guilherme H D

OBJECTIVESTo identify, critically appraise and evaluate the performance measures of the available prediction models for outcomes in people with low back pain (LBP) receiving conservative treatment.STUDY DESIGN AND SETTINGIn this systematic review, literature searches were conducted in Embase, Medline, and cumulative index of nursing and allied health literature from their inception until February 2024. Studies containing follow-up assessment (eg, prospective cohort studies, registry-based studies) investigating prediction models of outcomes (eg, pain intensity and disability) for people with LBP receiving conservative treatment were included. Two independent reviewers performed the study selection, the data extraction using the Checklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies, and risk of bias assessment using the Prediction model Risk of Bias Assessment. Findings of individual studies were reported narratively taking into account the discrimination and calibration measures of the prediction models.RESULTSSeventy-five studies developing or investigating the validity of 216 models were included in this review. Most prediction models investigated people receiving physiotherapy treatment and most models included sociodemographic variables, clinical features, and self-reported measures as predictors. The discriminatory capacity of the internal validity of the 27 prediction models for pain intensity varied greatly showing a c-statistic ranging from 0.48 to 0.94. Similarly, the discriminatory capacity for 31 models for disability had the same pattern showing a c-statistic ranging from 0.48 to 0.86. The calibration measures of the internal validity of the prediction models predicting pain intensity and disability showed to be adequate. Only one of 3 studies testing the external validity of models to predict pain intensity and disability and reported both discrimination and calibration measures, which showed to be inadequate. The prediction models predicting the secondary outcomes (eg, self-reported recovery, quality of life, return to work) showed varied performance measures for internal validity, and only 2 studies tested the external validity of models although they did not provide performance the performance measures.CONCLUSIONSeveral prediction models have been developed for people with LBP receiving conservative treatment; however, most show inadequate discriminatory validity. A few studies externally validated the prediction models and future studies should focus on testing this before implementing in clinical practice.

2024-11-26·Proceedings of the National Academy of Sciences

Urban environments increase generalization of hummingbird–plant networks across climate gradients

Article

作者: Rigotto, Sarah Mendonça ; Silva, Paulo Antonio ; Parra, Juan L. ; Silva, Larissa Lais ; Souza, Camila S. ; Restrepo-González, Alejandro ; Lima-Passos, Jeane ; Dias Filho, Manoel Martins ; Sazima, Ivan ; Costa, Carolina Figuerêdo ; Acevedo-Quintero, Juan Fernando ; Santana, Carina Araujo ; Márquez-Luna, Ubaldo ; Rech, André R. ; Ramírez-Burbano, Mónica B. ; Santos, Vinicius Calda ; Sandoval, Luis ; Hachuy-Filho, Leandro ; Wolowski, Marina ; Nakamura, Vivian ; Bosenbecker, Camila ; Maglianesi, María A. ; Mesa, Juan Guillermo ; Maruyama, Pietro Kiyoshi ; Ballarin, Caio S. ; Nunes Neto, Edvaldo ; Ruiz, Diana Betancur ; Machado, Caio Graco ; Gomes, Ana Caroline Silva ; Oliveira, Paulo E. ; Ferreira, Fernando Henrique Santos ; Cardoso, João Custódio F. ; da Frota, Angélica Vilas Boas ; Lara, Carlos ; Dalsgaard, Bo ; Rodríguez-Flores, Claudia I. ; Zanata, Thais B. ; Araujo, Andréa Cardoso ; Maianne, Monique ; Montoya-Arango, Sergio ; Nunes, Cristiane Estrêla C. ; Oliveira, Rafael ; Mendes, Ruara Soares ; Anselmo, Pedro Amaral ; Cherutte, Amanda Graciela ; Pereira, Janayna Andreza S. ; Rodrigues, Bruno Magro ; Vargas-Espinosa, Maria Cristina ; de Araújo, Francielle Paulina ; Fernández Otárola, Mauricio ; Iepsen, Alice Scheer ; Amorim, Felipe W. ; Castillo-García, Alejandra ; Brito, Lucilene ; Vizentin-Bugoni, Jeferson ; Rui, Ana Maria ; Lopes, Ariadna Valentina ; de Almeida, Ingrid Gabriela ; Sonne, Jesper ; Lasprilla, Liliana Rosero ; del Coro Arizmendi, María ; Almeida, Gabriela ; Pena, João Carlos ; Vitorino, Breno Dias ; Llano, Julian ; Leguizamón, Johana ; Freitas, Leandro ; Marin-Gomez, Oscar ; Sazima, Marlies ; Silva, Jéssica Luiza S.

Urbanization has reshaped the distribution of biodiversity on Earth, but we are only beginning to understand its effects on ecological communities. While urbanization may have homogenization effects strong enough to blur the large-scale patterns in interaction networks, urban community patterns may still be associated with climate gradients reflecting large-scale biogeographical processes. Using 103 hummingbird–plant mutualistic networks across continental Americas, including 176 hummingbird and 1,180 plant species, we asked how urbanization affects species interactions over large climate gradients. Urban networks were more generalized, exhibiting greater interaction overlap. Higher generalization was also associated with lower precipitation in both urban and natural areas, indicating that climate affects networks irrespective of habitat type. Urban habitats also showed lower hummingbird functional trait diversity and over/underrepresentation of specific clades. From the plant side, urban communities had a higher prevalence of nonnative nectar plants, which were more frequently visited by the hummingbird species occurring in both urban and natural areas. Therefore, urbanization affected hummingbird–plant interactions through both the composition of species and traits, as well as floral resource availability. Taken together, we show that urbanization consistently modifies ecological communities and their interactions, but climate still plays a role in affecting the structure of these novel communities over the scale of continents.

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