Influence of a Rehabilitation in Valve Replacement on Heart Rate Variability and Oxidative Stress
Condition: Cardiac Valve Disease
MeSH terms: Heart Valve Diseases
Study type: Interventional

Summary: 
      4 consecutive days with volunteers between the first and fourth postoperative period of
      cardiac valve replacement. The volunteers are randomized into 2 groups: the Control Group
      submitted to cardiac rehabilitation protocol of the hospital where it will be conducted the
      study, which consists of respiratory and metabolic exercises. The second group, called Early
      Mobilization Group in addition to the aforementioned exercises will be added exercise in
      cycle ergometer. For the implementation of rehabilitation protocol in the early mobilization
      group volunteers will be placed in a sitting position in the bed with the backrest raised to
      45 °. The exercise in cycle ergometer will be held for 20 minutes on four consecutive days of
      active mode, the training load shall be such that the voluntary maintained throughout
      training a level of fatigue, maintaining level of heart rate predicted for age increased by
      70% and 1 w / cm2 every minute to keep the parameter within the standards. The evaluation of
      heart rate variability with the Polar monitor RS800CX brand model before surgery was
      performed first postoperative day and fifth postoperative day in the control groups and early
      mobilization.
    

Detailed description: 
      The valve disorders are a special group of heart diseases with long period without clinical
      manifestations, when there is the appearance of symptoms, the patient is a likely candidate
      for surgery. In many surgical complications can occur, including the respiratory cause and
      immobility in bed culminating in the need for intensive care. Early mobilization exercises
      conducted by physical therapy in critically ill patients is to minimize complications related
      to immobility in bed from surgery that is performed in exchanges of heart valves. To
      investigate the influence of a cardiac rehabilitation program on cardiac function (Heart Rate
      Varibility) and free radicals (oxidative stress) in patients undergoing surgical heart valve
      replacement. The study is being conducted at the Clinical Hospital Gaspar Viana of Belém, in
      March 2014 period to March 2016, with the proposing institution the Methodist University of
      Piracicaba. The study included 60 volunteers aged 18 to 60 year old male with surgery
      scheduling of heart valve replacement. The volunteers were divided into 2 groups the control
      group who underwent rehabilitation proposed by the hospital with simple exercises like deep
      breathing exercises to improve cough, move your arms and rhythmically legs to maintain joint
      mobility, the second group It was called Early Mobilization Group, where volunteers beyond
      rehabilitation protocol proposed by the hospital, held exercises in a cycle ergometer, The
      volunteers were instructed to pedal lying comfortably with moderate intensity for 30 minutes.
      All groups performed this protocol lasting 4 days. Oxidative stress was analyzed and cardiac
      function before surgery, after surgery in the first and fifth postoperative. The Oxidative
      Stress is analyzed by puncturing a drop of blood and to analyze the photographed area
      coagulum formed. Cardiac function (Heart Rate Variability) will be analyzed using a heart
      rate monitor brand Polar® RS800CX model being evaluated lying down, then the data is
      transferred to the computer and analyzed in a program called Kubios HRV. After collecting the
      data will be analyzed in Biostat 5.2 program. The possible risks to the research subject is
      the inconvenience of collecting the blood sample, the onset of pain resulting from the
      mobilization of the rehabilitation protocol. However, the emergence of at least one of the
      risks mentioned above, the procedure and / or service must be stopped and perform passive
      stretching or temporary home until everything returns to normal. In addition, there may be a
      risk of contamination to volunteer for collecting blood, however this risk is minimized when
      using materials such as sterile needles and blades. The research brings benefit as increased
      range of motion and muscle strength, decreased pain, functional improvement, providing
      improvement in quality of life and functional independence and reduced hospital stay.
    

Intervention name(s): physical therapy procedure
Intervention type(s): Other
Intervention description(s): physiotherapy exercises conducted in early way for the rehabilitation of patients in the postoperative period of cardiac valve replacement.
Other intervention name(s): early mobilization
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: valve replacement; physical therapy; early mobilization