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using a reversible anticholinesterase agent during exercise&#44; confirmed that parasympathetic activity is the main reason for variations in HR fall in the recovery period&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Since then&#44; several other studies have confirmed that individuals with an attenuated HRR response at one minute after exercise testing present a greater risk of death&#44; independent of their exercise capacity&#44; severity of coronary artery disease &#40;CAD&#41; and left ventricular function&#44; even in patients with no cardiovascular symptoms&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">5&#8211;7</span></a> Most studies use a fall in HR of 12 bpm between peak exercise and one minute of recovery as the cut-off when assessing parasympathetic modulation&#44; a figure endorsed by the Brazilian Society of Cardiology in its latest guidelines on exercise testing&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">8&#44;9</span></a> A decrease of &#62;12 bpm represents a normal response&#44; while a fall of &#8804;12 may indicate parasympathetic dysautonomia&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Patients with cardiovascular disease undergoing a cardiac rehabilitation &#40;CR&#41; program&#44; based mainly on regular exercise&#44; show clear functional improvement with a favorable impact on prognosis&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">10</span></a> Previous studies have shown that the exercise component of a CR program improves HRR after peak exercise&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">11&#8211;16</span></a> However&#44; Currie et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">17</span></a> found no effect on HRR after 12 weeks of high-intensity interval and moderate-intensity endurance exercise training in patients with CAD&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Against this background&#44; the aim of the present study was to analyze the effects of a CR program on functional capacity and autonomic modulation&#44; bearing in mind the strong prognostic impact of these variables&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">The study population consisted of all patients with stable CAD who completed at least six months of a supervised CR program at a tertiary cardiology center between May 2009 and December 2014&#46; Data collected from medical records included baseline and post-CR exercise test results&#44; use of negative chronotropic drugs and diagnosis of diabetes&#44; together with demographic and anthropometric data&#46; Patients with permanent atrial fibrillation and those with pacemakers were excluded&#44; since these can affect HRR response&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Patients were assessed through exercise testing immediately before and after participation in the CR program&#46; The test was performed on a treadmill using an individualized ramp protocol designed to achieve peak exercise in 10 min&#46; There was an active recovery period of at least 5 min&#46; The first minute of recovery was standardized at a speed of 1&#46;5 mph and slope of 2&#46;5&#37;&#44; as in Cole et al&#46;&#44; which defined a decrease in HR of &#8804;12 bpm from peak exercise to one minute after the cessation of exercise as a marker of poor prognosis&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In the present study&#44; exercise tolerance was assessed in metabolic equivalents &#40;METs&#41; and HRR response in bpm in CAD patients participating in a CR program based on exercise training&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">A Centurion-200 treadmill &#40;Micromed<span class="elsevierStyleSup">&#174;</span>&#41; linked to a computer with ERGO PC<span class="elsevierStyleSup">&#174;</span> software &#40;Micromed&#41; was used for the tests&#44; with 13-lead electrocardiographic monitoring&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The supervised exercise program consisted of two or three weekly sessions lasting 60&#8211;75 min&#46; Each session included continuous aerobic exercise lasting 30&#8211;40 min&#44; followed by resistance training and flexibility exercises&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">During the aerobic component&#44; patients&#8217; exercise was monitored in order to keep their HR within the target range determined by exercise testing&#44; which defines the effective level of training and conditioning while maintaining a margin of safety&#46; This was set at 60&#8211;80&#37; of peak exercise HR&#44; using the Karvonen formula&#46; In patients with ischemia&#44; a value of 10 bpm below the ischemic threshold was used&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">In all cases&#44; the target HR was adapted according to the modified Borg scale of perceived exertion&#44; which enables the intensity of exercise to take account of the patient&#39;s fitness level on any given day&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The initial volume and intensity of resistance training&#44; and their progression&#44; were determined in accordance with international guidelines&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">18&#8211;20</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Exercise testing and the CR program were performed in the same tertiary cardiology center&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Ethical considerations</span><p id="par0075" class="elsevierStylePara elsevierViewall">This research project was conducted in accordance with Brazilian National Health Council Resolution 466&#47;12 and complementary resolutions&#44; and with the 1988 Brazilian Code of Medical Ethics &#40;articles 122&#8211;130&#41;&#46; The research protocol was approved by the center&#39;s Research Ethics Committee&#46; Since the study was based on a retrospective analysis of medical records with no intervention in the patients&#44; who had been referred for CR by their physicians&#44; the Ethics Committee waived the requirement for informed consent&#44; while ensuring the anonymity of the subjects and confidentiality of their data&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Statistical analysis</span><p id="par0080" class="elsevierStylePara elsevierViewall">The study population was divided into two groups according to baseline HRR at one minute&#58; &#8804;12 bpm and &#62;12 bpm&#46; Analysis of variance of four factors &#40;HRR group&#44; time&#44; presence of diabetes&#44; medication&#41; and their interactions was used to assess the effect of exercise training&#46; Inclusion of the latter two factors was designed to control for their possible confounding effect&#46; The analysis was applied for each of the variables under study &#40;METs and HRR&#41;&#44; differences being considered significant for p&#60;0&#46;05&#46; The Tukey-Kramer test was used when necessary to identify differences&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0085" class="elsevierStylePara elsevierViewall">The baseline characteristics of the study population of 248 individuals are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#44; divided into two groups according to their pre-training HRR&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a> shows the pre- and post-training METs for the two groups&#46; The HRR &#62;12 bpm group had higher MET values than the HRR &#8804;12 bpm group&#44; both before and after CR &#40;F&#61;50&#46;02&#59; p&#60;0&#46;001&#41;&#46; However&#44; both groups showed significant improvement in METs after CR &#40;F&#61;224&#46;70&#59; p&#60;0&#46;001&#41;&#46; The absence of significant interaction between the factors HRR group and time &#40;F&#61;2&#46;96&#59; p&#61;0&#46;087&#41; indicates that the two groups had similar gains in MET values following exercise training&#46; The presence of diabetes had a significant effect on METs &#40;F&#61;14&#46;59&#59; p&#60;0&#46;001&#41;&#44; with diabetic individuals presenting lower values than those without diabetes&#44; independently of HRR and time&#46; No other interactions were observed&#44; nor any significant effect of medication&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a> shows that there were significant differences between the two groups in terms of HRR &#40;F&#61;143&#46;41&#59; p&#60;0&#46;001&#41;&#46; No effect of training was seen in the group with HRR &#62;12 bpm&#44; as shown by the significant interaction between group and time &#40;F&#61;16&#46;13&#59; p&#60;0&#46;001&#41;&#44; and the presence of diabetes had only a marginal effect&#46; Although in the HRR &#8804;12 bpm group only those without diabetes achieved significant improvement in HRR following CR &#40;F&#61;5&#46;27&#59; p&#61;0&#46;026&#41;&#44; those with diabetes and parasympathetic dysautonomia also showed a tendency to improve&#59; the fact that this was not significant was probably due to the small number in this group &#40;n&#61;23&#41;&#46; Overall&#44; HRR normalized in the HRR &#8804;12 bpm group&#44; from 7&#46;4&#177;3&#46;69 bpm to 13&#46;0&#177;9&#46;74 bpm&#46; Use of negative chronotropic agents was similar in the two groups and this variable had no influence on the effect of training on HRR &#40;F&#61;1&#46;43&#59; p&#61;0&#46;233&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">There is irrefutable scientific evidence that regular exercise improves many physiological parameters&#44; including functional capacity and peak oxygen uptake&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">21</span></a> The aim of the present study was to assess changes in functional capacity and HRR following an exercise-based CR program&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">With regard to functional capacity&#44; our results show that improvement was independent of initial autonomic function&#46; Both groups improved following exercise training&#44; with no statistical difference&#46; It should be noted that the HRR &#8804;12 bpm group presented significantly worse aerobic condition on baseline assessment&#44; reflecting greater clinical severity based on two different parameters&#46; Following training&#44; this group went from a condition associated with worse prognosis to one close to that considered low risk according to the literature &#40;6&#46;97&#177;1&#46;65 METs as against 7 METs in the South American Guidelines for Cardiovascular Disease Prevention and Rehabilitation<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">22</span></a>&#41;&#46; While slightly lower than recommended&#44; the change is significant&#44; since every 1-MET increase in exercise capacity is associated with a 12&#37; improvement in survival&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">23</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Our results are in agreement with previous studies that demonstrated the positive impact of exercise training on autonomic function&#44; as reflected in improved HRR&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">11&#44;13&#8211;16</span></a> Only Currie et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">17</span></a> found no effect on HRR after 12 weeks of high-intensity interval and moderate-intensity endurance exercise training&#44; despite improvement in physical fitness&#59; however in their study&#44; unlike in ours and others&#44; the individuals assessed did not present dysautonomia prior to training&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">In this respect&#44; our results are similar to those of Streuber et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">12</span></a> who showed that HRR improved or normalized in individuals with autonomic dysfunction at the beginning of a CR program&#44; while those with HRR initially within the normal range remained so&#44; with no additional gain&#46; In our study&#44; those who presented parasympathetic dysautonomia at initial assessment achieved a mean increase in HRR from 7&#46;4&#177;3&#46;69 bpm to 13&#46;7&#177;9&#46;74&#44; thus going from a value considered pathological to one considered normal&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Despite a more than 70&#37; improvement in HRR&#44; 29 individuals in the HRR &#8804;12 bpm group remained in that range&#44; while HRR normalized in the other 26 patients&#44; corresponding to 47&#46;3&#37; of the group&#46; This is similar to the figure reported by Jolly et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">15</span></a> who analyzed 544 patients and found that 41&#37; had normal HRR after rehabilitation&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Normalization of HRR is an important effect of exercise training&#44; as various studies have shown that an attenuated HRR response following exercise testing is a predictor of mortality&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">3&#44;5&#8211;7</span></a> A considerable proportion of our study population had normal HRR after CR&#46; This is significant&#44; since individuals with autonomic dysfunction before training who achieve normal HRR after training appear to have similar survival rates to those with normal HRR at baseline and after cardiac rehabilitation&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">15</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">The present study has certain limitations&#46; It was retrospective and as such has the limitations inherent to this type of study&#46; However&#44; our sample was representative of real-world patients since the only exclusion criteria were conditions that would make it impossible to accurately assess HR&#44; and thus no patients were excluded based on disease severity or the presence of comorbidities&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Assessment of functional capacity was limited to conventional exercise testing&#44; and thus peak oxygen uptake was only estimated&#44; and temporary technical problems prevented analysis of expired gases and oxygen uptake&#46; However&#44; this did not affect the main finding of our study since HR behavior during the test would have been the same&#44; irrespective of whether oxygen uptake was measured directly or estimated&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Finally&#44; we did not use HR variability to assess autonomic modulation&#44; but rather a parameter that has been used in various studies for this purpose &#8211; HRR response at one minute of recovery&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">1&#8211;3</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusions</span><p id="par0145" class="elsevierStylePara elsevierViewall">Our results show that cardiac rehabilitation has an important impact on prognosis&#46; The exercise-based CR program played a positive role in a high-risk group that had both low functional capacity and reduced parasympathetic activity&#44; producing a markedly favorable effect on these recognized prognostic markers&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Ethical responsibilities</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Protection of people and animals</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors state that the procedures followed were in accordance with regulations established by the heads of the Clinical and Research Ethics Commission and according to the World Medical Association and the Declaration of Helsinki&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Data confidentiality</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Right to privacy and informed consent</span><p id="par0160" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Funding sources</span><p id="par0165" class="elsevierStylePara elsevierViewall">The present study received no external funding&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflicts of interest</span><p id="par0170" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">An attenuated heart rate recovery &#40;HRR&#41; response after exercise testing is a robust predictor of mortality&#46; Regular exercise can enhance various physiological parameters&#46; Studies indicate that participation in a cardiac rehabilitation program can improve heart rate recovery&#46; The aim of this study was to analyze changes in functional capacity and autonomic modulation in patients following a cardiac rehabilitation program&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Between 2009 and 2014&#44; 248 individuals were assessed through exercise testing&#44; at baseline and after six months of participation in a cardiac rehabilitation program&#46; The exercise test was performed on a treadmill using a ramp protocol&#46; The first minute of active recovery was standardized at a speed of 1&#46;5 mph and slope of 2&#46;5&#37;&#46; The degree of parasympathetic modulation was assessed by the difference between peak exercise heart rate and heart rate at one minute of recovery&#46; The subjects were divided into two groups according to pre-training HRR &#40;&#8804;12 bpm and &#62;12 bpm&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Exercise training resulted in a similar increase in metabolic equivalent values in both groups&#44; but only the HRR &#8804;12 bpm group showed improvement after training &#40;F&#61;16&#46;13&#59; p&#60;0&#46;001&#41;&#44; with a mean increase from 7&#46;4&#177;3&#46;69 bpm to 13&#46;0&#177;9&#46;74 bpm&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The cardiac rehabilitation program had a positive impact in a group that had both low functional capacity and reduced parasympathetic activity&#44; producing a favorable effect on these recognized prognostic markers&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o e objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A resposta atenuada da recupera&#231;&#227;o da frequ&#234;ncia card&#237;aca ap&#243;s o teste de exerc&#237;cio &#233; um robusto preditor de mortalidade&#46; A pr&#225;tica regular de atividade f&#237;sica &#233; capaz de aprimorar diversos par&#226;metros fisiol&#243;gicos&#46; Estudos indicam que a participa&#231;&#227;o em programa de reabilita&#231;&#227;o card&#237;aca pode melhorar a recupera&#231;&#227;o da frequ&#234;ncia card&#237;aca&#46; Assim&#44; o objetivo deste estudo foi avaliar as modifica&#231;&#245;es na capacidade funcional e na modula&#231;&#227;o auton&#243;mica de participantes de um programa de reabilita&#231;&#227;o card&#237;aca&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Entre 2009-2014&#44; 248 indiv&#237;duos foram avaliados&#44; atrav&#233;s do teste de exerc&#237;cio&#44; antes e ap&#243;s seis meses de participa&#231;&#227;o em programa de reabilita&#231;&#227;o card&#237;aca&#46; O teste de exerc&#237;cio foi realizado em esteira rolante&#44; aplicando-se o protocolo em rampa&#46; A recupera&#231;&#227;o foi ativa e o primeiro minuto da recupera&#231;&#227;o foi padronizado&#44; com velocidade de 1&#44;5 mph e inclina&#231;&#227;o de 2&#44;5&#37;&#46; A intensidade da modula&#231;&#227;o auton&#243;mica foi avaliada atrav&#233;s da diferen&#231;a entre a frequ&#234;ncia card&#237;aca do pico do exerc&#237;cio e a do primeiro minuto da recupera&#231;&#227;o&#46; Os indiv&#237;duos foram divididos em dois grupos&#44; de acordo com a recupera&#231;&#227;o da frequ&#234;ncia card&#237;aca pr&#233;-treinamento &#40;RFC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>12 e RFC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>12&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">O treinamento promoveu aumento similar na capacidade funcional de ambos os grupos&#46; No entanto&#44; apenas o grupo RFC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>12 mostrou acentua&#231;&#227;o na recupera&#231;&#227;o da frequ&#234;ncia card&#237;aca &#40;F<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#44;13&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; aumentando&#44; em m&#233;dia&#44; de 7&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;69 bpm para 13&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;74 bpm&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">O programa de reabilita&#231;&#227;o card&#237;aca foi capaz de atuar favoravelmente em um grupo que possu&#237;a&#44; simultaneamente&#44; baixa capacidade funcional e reduzida atividade auton&#243;mica parassimp&#225;tica&#44; interferindo efetivamente nestes dois marcadores de progn&#243;stico&#46;</p></span>"
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            "titulo" => "M&#233;todos"
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          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclus&#245;es"
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      ]
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Nascimento PMC&#44; Vieira MC&#44; Sperandei S&#44; Serra SM&#46; Atividade f&#237;sica supervisionada melhora a modula&#231;&#227;o auton&#243;mica de participantes de reabilita&#231;&#227;o card&#237;aca&#46; Rev Port Cardiol&#46; 2016&#59;35&#58;19&#8211;24&#46;</p>"
      ]
    ]
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      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Pre- and post-training metabolic equivalent values in the two groups&#46; D&#58; diabetic&#59; METs&#58; metabolic equivalents&#59; ND&#58; non-diabetic&#59; CR&#58; cardiac rehabilitation&#59; &#8804;12 bpm&#58; group with baseline heart rate recovery &#8804;12 bpm&#59; &#62;12&#58; group with baseline heart rate recovery &#62;12 bpm&#59; a&#58; significant difference before and after CR&#59; b&#58; significant difference between non-diabetic and diabetic individuals&#59; c&#58; significant difference between groups&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Pre- and post-training heart rate recovery response in the two groups&#46; D&#58; diabetic&#59; ND&#58; non-diabetic&#59; CR&#58; cardiac rehabilitation&#59; &#8804;12 bpm&#58; group with baseline heart rate recovery &#8804;12 bpm&#59; &#62;12&#58; group with baseline heart rate recovery &#62;12 bpm&#59; a&#58; significant difference between groups&#59; b&#58; significant difference before and after CR&#59; c&#58; significant difference between non-diabetic and diabetic individuals&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">BMI&#58; body mass index&#59; CCB&#58; calcium channel blocker&#59; HR&#58; heart rate&#59; HRR&#58; heart rate recovery&#59; SD&#58; standard deviation&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HRR &#8804;12 bpm<br>n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HRR &#62;12 bpm<br>n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total<br>n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Gender</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48 &#40;87&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">148 &#40;76&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">196 &#40;79&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;12&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45 &#40;23&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52 &#40;21&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Age &#40;years&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8804;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;25&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63 &#40;32&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77 &#40;31&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>56&#8211;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19 &#40;34&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80 &#40;41&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">99 &#40;39&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;40&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50 &#40;25&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72 &#40;29&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#46;2 &#40;10&#46;83&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&#46;2 &#40;8&#46;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&#46;1 &#40;9&#46;31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">BMI &#40;kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8804;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;21&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44 &#40;22&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56 &#40;22&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43 &#40;78&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">149 &#40;77&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">192 &#40;77&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;9 &#40;4&#46;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;6 &#40;3&#46;78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;7 &#40;3&#46;85&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Diabetes</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32 &#40;58&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">137 &#40;71&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">169 &#40;68&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23 &#40;41&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56 &#40;29&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79 &#40;31&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Medication</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;6&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;5&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Beta-blocker&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42 &#40;76&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">167 &#40;86&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">209 &#40;84&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CCB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;3&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;3&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Amiodarone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;0&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Propafenone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Beta-blocker &#43; digoxin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;5&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;1&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;2&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Beta-blocker &#43; CCB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Beta-blocker &#43; amiodarone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;5&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;1&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Beta-blocker &#43; sotalol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;3&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;1&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;1&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Beta-blocker &#43; ivabradine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">HR&#44; mean &#40;SD&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Baseline&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&#46;9 &#40;13&#46;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&#46;4 &#40;12&#46;18&#41;&nbsp;\t\t\t\t\t\t\n
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