que se leu este artigo
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Could we go further?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "287" "paginaFinal" => "288" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Luís Martins Brízida" "autores" => array:1 [ 0 => array:4 [ "nombre" => "Luís" "apellidos" => "Martins Brízida" "email" => array:1 [ 0 => "brizidaluis@yahoo.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Hospital Amadora-Sintra Prof. Doutor Fernando Fonseca, Serviço de Cardiologia, Unidade Cuidados Intensivos Cardíacos (UCIC), Amadora, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidade Cardiovascular, Grupo Lusíadas Lisboa, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Estamos a dar o melhor aos nossos doentes de reabilitação cardíaca? Podemos ir um pouco mais além?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">There is no doubt that cardiac rehabilitation (CR) is a very effective therapeutic approach, associated with significant reductions in overall and cardiovascular mortality. It also improves patients’ quality of life and their functional capacity.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">One of the main components of a CR program is aerobic exercise, prescription of which is guided ideally by the heart rate (HR) achieved in cardiopulmonary exercise testing (CPET), based on parameters including peak oxygen uptake (VO<span class="elsevierStyleInf">2</span>) and VO<span class="elsevierStyleInf">2</span> reserve. However, because of the costs and limited availability of this test, conventional stress testing is more often used.</p><p id="par0015" class="elsevierStylePara elsevierViewall">There are two common methods for obtaining the target (training) HR. One is based on HR reserve (HRR), for which the guidelines<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3,4</span></a> specify a range of 40-80%. This method gives similar results to the gold standard CPET. The other method aims for 50-85% of peak HR.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In some situations it cannot be assumed that HR will have a linear relationship with VO<span class="elsevierStyleInf">2</span> and work rate increase, such as in pacemaker implantation, heart transplantation, chronotropic incompetence or beta-blocker therapy. In such cases an alternative is to use a rating of perceived exertion (RPE), as provided by the Borg scale. Target HR in this case will be determined by a score of 12-16 (on a scale from 6 to 20) on the Borg scale.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Target HR has been set by high-intensity interval training (HIIT) in some studies at a level of 80-90% of HRR.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The best method of determining target HR has not been clearly established, nor has the optimal progression of exercise intensity in the established range. A careful balance must be achieved between safety and performance.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Increases in the intensity of aerobic exercise can be guided by monitoring HR achieved during the sessions and the associated RPE.</p><p id="par0040" class="elsevierStylePara elsevierViewall">This issue of the <span class="elsevierStyleItalic">Journal</span> features a study by Amorim et al.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> of 238 randomly selected patients undergoing a CR program in the cardiac rehabilitation center of Centro Hospitalar de S. João, Porto, between 2008 and 2016, following an acute coronary syndrome. It aimed to describe the progression of aerobic exercise intensity in these patients, and revealed a significant improvement in functional capacity following the program.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The authors studied the progression of aerobic exercise intensity by measuring patients’ weekly peak exercise HR on the treadmill and exercise intensity in metabolic equivalents (METs), using the American College of Sports Medicine formulas based on the speed and grade of the treadmill.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">To quantify improvement in functional capacity due to the program, they indexed the peak HR achieved in the sessions and the RPE score to the intensity of exercise (in METs).</p><p id="par0055" class="elsevierStylePara elsevierViewall">The results were as expected, with significant increases in functional capacity, and greater intensity of exercise with lower perception of effort.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The study revealed that the patients trained at the upper end of the recommended range by the peak HR method, but at the lower end of the recommended range by the HRR method (which is more reliable and is closer to measured VO<span class="elsevierStyleInf">2</span>) guided by RPE and peak HR achieved in aerobic sessions during treadmill exercise. This supports the idea that there may be room to increase the intensity of training, such as by raising the RPE score to 14-16, in selected patients.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The authors conclude that the major changes resulting from exercise occurred during the first month of training, with less visible change in functional capacity thereafter, especially in older patients. This highlights the need for a different approach to these patients, to enable them to achieve better results.</p><p id="par0070" class="elsevierStylePara elsevierViewall">In conclusion, there is room for further improvement in the benefits provided by a conventionally structured CR program, in particular by introducing more ambitious goals in progression of exercise intensity in some patients and by diversifying the program schemes.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exercise-based cardiac rehabilitation for coronary heart disease. 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Ano/Mês | Html | Total | |
---|---|---|---|
2024 Novembro | 9 | 8 | 17 |
2024 Outubro | 28 | 26 | 54 |
2024 Setembro | 40 | 30 | 70 |
2024 Agosto | 37 | 34 | 71 |
2024 Julho | 31 | 28 | 59 |
2024 Junho | 20 | 26 | 46 |
2024 Maio | 31 | 17 | 48 |
2024 Abril | 25 | 28 | 53 |
2024 Maro | 32 | 23 | 55 |
2024 Fevereiro | 29 | 29 | 58 |
2024 Janeiro | 30 | 20 | 50 |
2023 Dezembro | 24 | 20 | 44 |
2023 Novembro | 29 | 32 | 61 |
2023 Outubro | 18 | 15 | 33 |
2023 Setembro | 19 | 12 | 31 |
2023 Agosto | 24 | 22 | 46 |
2023 Julho | 26 | 9 | 35 |
2023 Junho | 23 | 9 | 32 |
2023 Maio | 28 | 25 | 53 |
2023 Abril | 21 | 6 | 27 |
2023 Maro | 22 | 28 | 50 |
2023 Fevereiro | 19 | 21 | 40 |
2023 Janeiro | 16 | 20 | 36 |
2022 Dezembro | 26 | 22 | 48 |
2022 Novembro | 32 | 29 | 61 |
2022 Outubro | 34 | 25 | 59 |
2022 Setembro | 27 | 35 | 62 |
2022 Agosto | 19 | 38 | 57 |
2022 Julho | 25 | 44 | 69 |
2022 Junho | 22 | 29 | 51 |
2022 Maio | 20 | 34 | 54 |
2022 Abril | 28 | 33 | 61 |
2022 Maro | 26 | 37 | 63 |
2022 Fevereiro | 23 | 41 | 64 |
2022 Janeiro | 32 | 36 | 68 |
2021 Dezembro | 36 | 39 | 75 |
2021 Novembro | 38 | 39 | 77 |
2021 Outubro | 27 | 56 | 83 |
2021 Setembro | 29 | 29 | 58 |
2021 Agosto | 23 | 28 | 51 |
2021 Julho | 17 | 20 | 37 |
2021 Junho | 16 | 14 | 30 |
2021 Maio | 24 | 35 | 59 |
2021 Abril | 38 | 26 | 64 |
2021 Maro | 51 | 23 | 74 |
2021 Fevereiro | 49 | 16 | 65 |
2021 Janeiro | 21 | 19 | 40 |
2020 Dezembro | 37 | 14 | 51 |
2020 Novembro | 10 | 23 | 33 |
2020 Outubro | 21 | 21 | 42 |
2020 Setembro | 26 | 11 | 37 |
2020 Agosto | 11 | 9 | 20 |
2020 Julho | 29 | 10 | 39 |
2020 Junho | 33 | 9 | 42 |
2020 Maio | 11 | 13 | 24 |
2020 Abril | 30 | 11 | 41 |
2020 Maro | 42 | 17 | 59 |
2020 Fevereiro | 60 | 51 | 111 |
2020 Janeiro | 30 | 16 | 46 |
2019 Dezembro | 29 | 13 | 42 |
2019 Novembro | 22 | 8 | 30 |
2019 Outubro | 53 | 12 | 65 |
2019 Setembro | 81 | 6 | 87 |
2019 Agosto | 25 | 12 | 37 |
2019 Julho | 53 | 19 | 72 |
2019 Junho | 49 | 53 | 102 |
2019 Maio | 3 | 6 | 9 |