Rehabilitation With Exercises in Cardiovascular Diseases
Condition: Cardiovascular Diseases
MeSH terms: Cardiovascular Diseases
Study type: Interventional

Summary: 
      INTRODUCTION: Cardiovascular diseases are the main causes of death in Brazil and in the
      world, associated with a large number of people with physical disabilities and disability,
      significantly burdening public health expenditures. Some patients end up having the need to
      do cardiac surgeries. , and consequently suffer complications associated with the surgical
      process due to prolonged rest in the bed, and complications are directly related to the
      morbidity and mortality rate in these patients. Thus, cardiac rehabilitation has great
      scientific evidences that directly impacts functional capacity, quality of life and thus
      reducing the morbimortality rate of these patients. However, it is worth noting that there is
      no outpatient cardiovascular rehabilitation service linked to the single health system (SUS)
      in the Amazon Region, that is, involving phase III of cardiac rehabilitation with defined and
      structured protocols for the group of patients already mentioned. OBJECTIVE: To analyze the
      clinical evolution of patients in the postoperative period of coronary artery bypass grafting
      and / or valve replacement (phase III), in outpatient treatment. METHODOLOGY: It is a a
      longitudinal study, with quantitative variables to be performed in a single center within a
      year (12 months). Which will evaluate the effects of phase III cardiac rehabilitation of
      patients undergoing cardiac surgery through an evaluation, which will evaluate heart rate
      variability, functional capacity by six-minute walk test, pulmonary volumes and capacities by
      spirometry, percutaneous strength and ventilatory muscle, MRC scale and manovacuometry,
      respectively, and the application of a quality of life assessment questionnaire.
      Subsequently, the protocol of 20 sessions will be applied and at the end the same variables
      will be re-evaluated. EXPECTED RESULTS: It is expected from the application of this research
      that the protocol suggested for the phase III cardiac rehabilitation of patients submitted to
      cardiac surgery will bring benefits to patients, such as improvement in heart rate
      variability, improvement in functional capacity, improvement in quality of life, and
      reduction in morbidity and mortality rates.
    

Detailed description: 
      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.
    

Intervention name(s): Physical exercise; monitoring
Intervention type(s): Other; Other
Intervention description(s): Participants will perform physical exercises with constant, or intermittent professional supervision or will interrupt the exercise after ambulatorial physical therapy; the patients will be under monitoring to investigate the evolution of the disease
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: BLINDED AND RANDOMIZED CLINICAL TRIAL
Masking: Single (Investigator)
Primary purpose: Treatment
Keywords: REHABILITATION; PHYSICAL THERAPY; CARDIOVASCULAR DISEASE