Rehabilitation With Exercises in Cardiovascular Diseases
কীওয়ার্ডস
বিমূর্ত
বর্ণনা
Characterized by the insufficiency of blood supply to the heart through the coronary arteries, coronary artery disease (CAD) stands out as a global health problem, since it represents the main cause of morbidity and mortality and is among the pathologies with the greatest clinical and significantly increasing public health expenditures. In Brazil, it is estimated that CAD corresponds to 80% of deaths due to cardiovascular diseases (CVD), mainly in large centers and in the population with age over 40 years. CAD is associated with risk factors such as systemic arterial hypertension, smoking, dyslipidemia, obesity, diabetes mellitus, sedentary lifestyle, and in addition to the family history of coronary insufficiency, that favors its onset.
The process of treatment of CAD is variable according to the level of involvement, and can be performed through drugs, physical activities, nutritional control and surgical procedure. Cardiac surgery is an alternative to promote improvement of cardiovascular function in addition to reduction of morbimortality rates due to circulatory diseases, only performed when clinical treatment is not able to provide cure and / or improvement of patient's quality of life. Myocardial revascularization (CABG) surgery is one of the most accomplished cardiac surgeries in Brazil, and it is currently recognized as a well-established procedure for the treatment of CAD, since it is capable of prolonging and improving the quality of life of these patients.
CABG aims at the resolution of myocardial ischemia, seeking the relief of symptoms and consequently improvement of patient survival, biopsychosocial well-being, as well as the earlier return to their daily activities, however, because it is an invasive procedure and complexity, can imply several systemic repercussions such as cardiac, renal, infectious, motor and pulmonary alterations. The postoperative complications of CABG depend on factors related to the clinical situation at the time of surgery, such as age, life habits, comorbidities, and also factors associated with the surgical process, such as duration of surgery, use of extracorporeal circulation, schedules and the long-term invasive mechanical ventilation and hospitalization.
Respiratory complications after CABG contribute to the reduction of the patients' quality of life and increased morbimortality rates. Decreased respiratory muscle strength may be a result of respiratory muscle injury during surgery and / or secondary to diaphragmatic dysfunction due to phrenic nerve injury. Respiratory muscle weakness may compromise the ventilation structure and function of these patients, exacerbating dyspnea, effort intolerance, decreased ability to perform physical exercise, and consequently reduced functional capacity (FC) of the individuals. The FC has a direct impact on the performance of activities of daily living (ADLs), and in this context, the practice of physical exercise after cardiac surgery is essential in the functional recovery of patients.
Cardiovascular rehabilitation (CVR) has a "1" level of recommendation and "A" grade of scientific evidence, and physiotherapy has been the main component in this process, being strongly associated with increased exercise capacity, improved dyspnea, quality of life, as well as a decrease in mortality and morbidity rates, leading to an increase in the life expectancy of these patients in the postoperative period .
Despite the well-known benefits of CVR, the number of patients participating in this program is considered small, only 34% of the candidates are targeted and in the end, only 20% of these candidates participate. In addition, as regards Phase IV rehabilitation, health management of patients is still limited as improvements in lifestyle behavior are often not maintained in the long run and levels of physical activity generally decline after a program of successful outpatient rehabilitation, resulting in the loss of adaptations acquired as a result of physical training.
তারিখ
সর্বশেষ যাচাই করা হয়েছে: | 12/31/2018 |
প্রথম জমা দেওয়া: | 12/02/2018 |
আনুমানিক তালিকাভুক্তি জমা দেওয়া হয়েছে: | 12/07/2018 |
প্রথম পোস্ট: | 12/10/2018 |
সর্বশেষ আপডেট জমা দেওয়া হয়েছে: | 01/30/2019 |
সর্বশেষ আপডেট পোস্ট: | 02/03/2019 |
আসল অধ্যয়ন শুরুর তারিখ: | 08/31/2018 |
আনুমানিক প্রাথমিক সমাপ্তির তারিখ: | 12/19/2020 |
আনুমানিক অধ্যয়ন সমাপ্তির তারিখ: | 06/30/2021 |
অবস্থা বা রোগ
হস্তক্ষেপ / চিকিত্সা
Other: Physical exercise
Other: Control group
পর্যায়
বাহু গ্রুপ
বাহু | হস্তক্ষেপ / চিকিত্সা |
---|---|
Experimental: Home based intervention will be submitted to a total of 24 sessions of an unsupervised Cardiovascular Physical Therapy protocol, composed of the following steps: warm up, proper training (aerobic training + muscle training for upper and lower limbs with theraband in 5 series with 10 repetitions) often three times a week for eight weeks. | |
Placebo Comparator: Control group Will not be submitted to the Cardiovascular Physiotherapy Rehabilitation protocol for unsupervised domiciliary, only monitorization of cardiovascular variables. | Other: Control group the patients will be under monitoring to investigate the evolution of the disease |
Active Comparator: Professional seupervision based eight weeks of supervised activities by professional. Each day and for 20 days (20 sessions), volunteers will undergo exercises on cycle ergometer during 30 minutes for upper and lower limbs |
যোগ্যতার মানদণ্ড
বয়স অধ্যয়নের জন্য যোগ্য | 40 Years প্রতি 40 Years |
লিঙ্গ অধ্যয়নের জন্য যোগ্য | All |
স্বাস্থ্যকর স্বেচ্ছাসেবীদের গ্রহণ করে | হ্যাঁ |
নির্ণায়ক | Inclusion Criteria: - Patients undergoing cardiac surgery; - Both sexes and age group between 40 and 70 years; - Who were discharged from ambulatory; - That they agree to participate in the survey Exclusion Criteria: - Patients with Osteomioarticular diseases in upper and lower limbs and neurological diseases that may interfere with the performance of the exercises proposed in the protocol. - Female patients in the climacteric. - Patients with cardiovascular diseases such as uncontrolled arterial hypertension, arrhythmias that use cardiac pacemakers, infectious diseases that affect the cardiovascular system such as Chagas disease, Heart Failure and / or patients with diabetes mellitus. - With simultaneous lung diseases, such as asthma, COPD, collagen diseases (eg, scleroderma) and sarcoidosis. - Occupational diseases, such as pneumoconiosis, hypersensitivity pneumonia. |
ফলাফল
প্রাথমিক ফলাফল ব্যবস্থা
1. Heart rate variability [during 3 months]
2. Respiratoey muscle strenght [during 3 months]