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The present study aimed to perform a cost-effectiveness analysis of an exercise-based cardiovascular rehabilitation (CR) program in patients with chronic Chagas cardiomyopathy (CCC).Cost-effectiveness analysis alongside a randomised clinical trial evaluating the effects of a 6-month exercise-based CR program. The intervention group underwent 3 weekly exercise sessions. The variation of peak oxygen consumption (VOThe intervention group presented higher costs with healthcare visits (β = +3317.3; p 0.001), hospitalisation (β = +2810.4; p = 0.02) and total cost (β = +6407.9; p 0.001) after 3 months of follow-up. Costs related to healthcare visits (β = +2455.8; p 0.001) and total cost (β = +4711.4; p 0.001) remained higher in the intervention group after 6 months. The CR program showed an incremental cost-effectiveness ratio (ICER) of $PPP 1874.3 for each increase of 1.0 ml kgThe CR program can be considered a cost-effective alternative and should be included as an intervention strategy in the care of patients with CCC.

To describe the clinical and sociodemographic characteristics of participants as well as discontinuation and mortality rates in a cardiac rehabilitation programme (CRP) tailored to Chagas disease (CD).Participants underwent functional capacity, anthropometry and cardiac function evaluations before beginning a CRP. Univariate and multivariate Cox proportional hazards models were performed to investigate the associations between clinical and sociodemographic characteristics at baseline with discontinuation rates and deaths.Forty-two patients were enrolled in the CRP (61.9% men, mean age of 58.1 ± 11.8 years). During a median follow-up period of 10.8 months, 74% discontinued and 14% died while enrolled in CRP. 34% of the patients who discontinued CRP died during follow-up. White race (HR = 0.09; 95% CI 0.01-1.00), right ventricular systolic dysfunction (HR = 10.54; 95% CI 1.24-89.50) and oxygen pulse (HR = 0.69; 95% CI 0.48-0.99) were independently associated with death while enrolled in CRP. Married status (HR = 0.44; 95% CI 0.21-0.95) was independently associated with discontinuation rates from CRP. VOIn this population, sociodemographic aspects and severity of CD were important determinants of CRP discontinuation and mortality.Décrire les caractéristiques cliniques et sociodémographiques des participants ainsi que les taux d'abandon et de décès dans un programme de réadaptation cardiaque (PRC) adapté à la maladie de Chagas (MC). MÉTHODES: Les participants ont subi des évaluations de la capacité fonctionnelle, de l'anthropométrie et de la fonction cardiaque avant de commencer un PRC. Des modèles de risques proportionnels de Cox univariés et multivariés ont été appliqués pour étudier les associations entre les caractéristiques cliniques et sociodémographiques au départ avec les taux d'abandon et les décès. RÉSULTATS: 42 patients ont été enrôlés dans le PRC (61,9% d'hommes, âge moyen de 58,1 ± 11,8 ans). Au cours d'une période médiane de suivi de 10,8 mois, 74% ont abandonné et 14% sont décédés durant leur enrôlement au PRC. 34% des patients qui ont arrêté le PRC sont décédés au cours du suivi. La race blanche (HR = 0,09; IC95%: 0,01-1,00), le dysfonctionnement systolique ventriculaire droite (HR = 10,54; IC95%: 1,24-89,50) et le pouls d'oxygène (HR = 0,69; IC95%: 0,48-0,99) étaient indépendamment associés avec le décès lors de l’enrôlement au PRC. Le statut marié (HR = 0,44; IC95%: 0,21-0,95) était indépendamment associé aux taux d'abandon de la CRP. Le pic de VO2 (HR = 0,85; IC95%: 0,74-0,98) et l'arrêt du PRC pour des raisons liées à la MC (HR = 8,33; IC95%: 1,91 à 36,27) étaient les variables indépendamment associées au décès après l'arrêt du PRC.Dans cette population, les aspects sociodémographiques et la sévérité de la MC étaient des déterminants importants de l'arrêt du PRC et du décès.

This study aimed to evaluate acute and subacute hemodynamic responses and perception of effort in individuals with CCC submitted to different IMT protocols.This was a randomized cross-over trial conducted on CCC subjects with systolic left ventricular dysfunction (45% left ventricular ejection fraction) without or with heart failure (stages B2 and C, respectively). Twenty-one participants performed two IMT protocols, one targeting 60% maximal inspiratory pressure with 3 × 10 repetitions (MIP60) and the other targeting 30% maximal inspiratory pressure (MIP30) with 3 × 20 repetitions with a 2 min recovery between sets for both. MIP60 and MIP30 were performed on the same day with a 2 h washout period. Measurements were taken at baseline, during and 60 min after IMT.No differences in hemodynamic variables were observed across protocols. The perception of effort increased in both protocols, with higher scores for the MIP30 protocol (β = +1.6,There were no differences in hemodynamic responses comparing MIP60 and MIP30 protocols in subjects with CCC. Despite the higher perception of effort during endurance protocol, both protocols can be considered a safe therapeutic strategy.IMPLICATIONS FOR REHABILITATIONDespite inspiratory muscle training may result in functional capacity improvements, no previous study evaluated the hemodynamic acute and subacute responses to inspiratory muscle training in chronic Chagas cardiomyopathy.The two inspiratory muscle training protocols (30% and 60% of maximal inspiratory pressure) did not cause significant hemodynamic repercussions in subjects with chronic Chagas cardiomyopathy.Inspiratory muscle training seems to be an effective strategy to improve functional capacity and can be implemented in the rehabilitation programs for patients with Chagas cardiomyopathy.Since no significant adverse responses were observed in any of the hemodynamic parameters during the inspiratory muscle training sessions, these two protocols of inspiratory muscle training (30% and 60% of maximal inspiratory pressure) seems to be safe in subjects with Chagas cardiomyopathy.

This cross-sectional study reports on the relationship between objectively-assessed quality of physical activity resources (PARs) and frequency of use within two low income neighborhoods in Rio de ...

Objective: The objective of this study was to evaluate the action of soy isoflavones (ISO) and 17β-estradiol on collagen I (CollI) and sulfated glycosaminoglycans (GAGs) in the bone matrix of diabe...

Covid-19 is a novel infectious disease whose spectrum of presentation ranges from absence of symptoms to widespread interstitial pneumonia associated with severe acute respiratory syndrome (SARS), leading to significant mortality. Given the systemic pattern of Covid-19, there are many factors that can influence patient's functional capacity after acute infection and the identification of such factors can contribute to the development of specific rehabilitation strategies. Pulmonary impairment is the primary cause of hospitalization due to Covid-19, and can progress to SARS as well as increase length of hospitalization. Moreover, cardiac involvement is observed in approximately 30% of hospitalized patients, with an increased risk of acute myocarditis, myocardial injury, and heart failure, which may compromise functional capacity in the long-term. Thromboembolic complications have also been reported in some patients with Covid-19 and are associated with a poor prognosis. Musculoskeletal complications may result from long periods of hospitalization and immobility, and can include fatigue, muscle weakness and polyneuropathy. Studies that address the functional capacity of patients after Covid-19 infection are still scarce. However, based on knowledge from the multiple systemic complications associated with Covid-19, it is reasonable to suggest that most patients, especially those who underwent prolonged hospitalization, will need a multiprofessional rehabilitation program. Further studies are needed to evaluate the functional impact and the rehabilitation strategies for patients affected by Covid-19.

The increase in life expectancy and the migration of individuals with Chagas disease (ChD) from rural to urban centers exposes them to the development of chronic-degenerative abnormalities that may increase the prevalence of metabolic syndrome (MetS). The present study aimed to identify the prevalence of MetS and its components in individuals with chronic ChD. This is a cross-sectional study with 361 patients of both sexes, aging >18 years, followed at a national reference center (Rio de Janeiro, Brazil). MetS diagnosis followed the International Diabetes Federation 2005 criteria. The association between the variables was determined through logistic regression models. The mean age was and 60.7±10.8 years. About half (56.2%) were female and the majority self-reported their race as mulatto (59.8%). The percentage of individuals with MetS was 40.4%. The variables independently associated with MetS were age (OR 1.06; 95%CI 1.04–1.09), high education levels (OR 0.36; 95%CI 0.17–0.79) and cardiac form with heart failure (OR 0.34; 95%CI 0.17–0.68). Therefore, a high prevalence of MetS was found in this Brazilian chronic ChD cohort. The identification of the associated factors can facilitate the development of effective approaches for preventing and managing MetS in ChD patients.

Objectives To evaluate the quality of life (QoL) of patients with Chagas disease (CD) and the association between QoL domains and several clinical, socioeconomic and lifestyle characteristics of this population. Methods Cross-sectional observational study conducted from March 2014 to March 2017 including a total of 361 outpatients followed at Evandro Chagas National Institute of Infectious Disease, Brazil. QoL was assessed using the Portuguese shorter version of the original WHO Quality of Life questionnaire (WHOQOL-BREF). Information about clinical CD presentation, presence of comorbidities, functional class, previous benznidazole treatment, socioeconomic profile and lifestyle was also obtained. Results Environment and physical domains presented the worst QoL scores, while the social relationship domain presented the highest score. Multivariate regression analysis demonstrated that variables independently associated with QoL were functional class, sex, clinical presentation of CD, sleep duration, schooling, physical activity level, smoking, income per capita and residents by domicile. Conclusions The low socioeconomic status and the physical limitations imposed by the disease presented an important impact on the QoL reduction among CD patients, especially on environment and physical domains. Strategies to improve QoL among CD patients should be tailored and consider many different variables to maximise improvements not only of patients' physical but also of their mental health.

Objectives To evaluate the attrition rate of members of a fitness center in the city of Rio de Janeiro and the potential explanatory variables for the phenomenon. Design An exploratory, observational study using a retrospective longitudinal frame. Methods The records of 5240 individuals, members of the fitness center between January-2005 and June-2014, were monitored for 12 months or until cancellation of membership, whichever occurred first. A Cox proportional hazard regression model was adjusted to identify variables associated to higher risk of ‘abandonment’ of activities. This study was approved by Southern Cross University's Human Research Ethics Committee (approval number: ECN-15-176). Results The general survival curve shows that 63% of new members will abandon activities before the third month, and less than 4% will remain for more than 12 months of continuous activity. The regression model showed that age, previous level of physical activity, initial body mass index and motivations related to weight loss, hypertrophy, health, and aesthetics are related to risk of abandonment. Combined, those variables represent an important difference in the probability to abandon the gym between individuals with the best and worse combination of variables. Even individuals presenting the best combination of variables still present a high risk of abandonment before completion of 12 months of fitness center membership. Conclusions Findings can assist in the identification of high risk individuals and therefore help in the development of strategies to prevent abandonment of physical activity practice.

The benefits of sport for general social outcomes has permeated sport policy in Brazil since the beginning of the twentieth century, but recently the jargon of “development through sport” is more overtly informing public policy and government action in this field. Despite increased uptake of the positive discourse of “sport as a development tool”, the reality for government-funded and -run “sport for development” programs is one far removed from enjoying the attention and financial investment needed to reach their stated development goals. This paper focuses on one such program: the Vilas Olimpicas do Rio de Janeiro. When analysing the specific matters associated with the management of this program three themes were identified that encapsulate the main issues that emerged during the analysis: partnerships, conflicting aims, and community involvement. These themes are analysed in light of the literature that discusses the application of “sport for development” programs worldwide and we conclude with some questions on the applicability of well-defined frameworks and approaches to such programs when these programs themselves tend to operate in very ill-defined and unstable environments.

Background and Objectives: An attenuated heart rate recovery (HRR) response after exercise testing is a robust predictor of mortality. Regular exercise can enhance various physiological parameters. Studies indicate that participation in a cardiac rehabilitation program can improve heart rate recovery. The aim of this study was to analyze changes in functional capacity and autonomic modulation in patients following a cardiac rehabilitation program. Methods: Between 2009 and 2014, 248 individuals were assessed through exercise testing, at baseline and after six months of participation in a cardiac rehabilitation program. The exercise test was performed on a treadmill using a ramp protocol. The first minute of active recovery was standardized at a speed of 1.5 mph and slope of 2.5%. The degree of parasympathetic modulation was assessed by the difference between peak exercise heart rate and heart rate at one minute of recovery. The subjects were divided into two groups according to pre-training HRR (≤12 bpm and >12 bpm). Results: Exercise training resulted in a similar increase in metabolic equivalent values in both groups, but only the HRR ≤12 bpm group showed improvement after training (F=16.13; p 12). Resultados: O treinamento promoveu aumento similar na capacidade funcional de ambos os grupos. No entanto, apenas o grupo RFC ≤ 12 mostrou acentuação na recuperação da frequência cardíaca (F = 16,13; p

Resumo: Introdução e objetivos: A resposta atenuada da recuperação da frequência cardíaca após o teste de exercício é um robusto preditor de mortalidade. A prática regular de atividade física é capaz de aprimorar diversos parâmetros fisiológicos. Estudos indicam que a participação em programa de reabilitação cardíaca pode melhorar a recuperação da frequência cardíaca. Assim, o objetivo deste estudo foi avaliar as modificações na capacidade funcional e na modulação autonómica de participantes de um programa de reabilitação cardíaca. Métodos: Entre 2009‐2014, 248 indivíduos foram avaliados, através do teste de exercício, antes e após seis meses de participação em programa de reabilitação cardíaca. O teste de exercício foi realizado em esteira rolante, aplicando‐se o protocolo em rampa. A recuperação foi ativa e o primeiro minuto da recuperação foi padronizado, com velocidade de 1,5 mph e inclinação de 2,5%. A intensidade da modulação autonómica foi avaliada através da diferença entre a frequência cardíaca do pico do exercício e a do primeiro minuto da recuperação. Os indivíduos foram divididos em dois grupos, de acordo com a recuperação da frequência cardíaca (RFC) pré‐treinamento (RFC ≤ 12 e RFC > 12). Resultados: O treinamento promoveu aumento similar na capacidade funcional de ambos os grupos. No entanto, apenas o grupo RFC ≤ 12 mostrou acentuação na recuperação da frequência cardíaca (F = 16,13; p 12 bpm). Results: Exercise training resulted in a similar increase in metabolic equivalent values in both groups, but only the HRR ≤12 bpm group showed improvement after training (F=16.13; p

The objective of this study was to analyze the physical activity patterns of women living in a low-income community located in close proximity to the 2016 Rio de Janeiro Olympic Park. Data (N = 140) were collected in June and July 2012 using the International Physical Activity Questionnaire. Findings indicated that the majority (54.8%) of participants reported high levels of physical activity. The domains that contributed the most to this pattern were occupational and household physical activity. Significantly, 88.1% of participants reported low physical activity levels during their leisure-time. In the transport-related domain, participants were relatively more active, but more than half of them (57%) spent less than 600 MET-minutes/week in this domain. The results highlighted the discrepancies between different physical activity domains. In addition, the findings also suggested that low-income women in our study engaged little in physical activity during their leisure time. Therefore, the proposed commitments found in the Rio de Janeiro Candidature File to host the 2016 Olympic Games to increase sport/physical activity participation within low-income communities in Rio de Janeiro need to be implemented effectively if this physical activity behavior during self-directed time is to be changed.

To assess the quality of public physical activity resources (PARs) in a low socio-economic community in the Olympic city of Rio de Janeiro. The Physical Activity Resource Assessment (PARA) instrument was used to assess all 29 public PARs located in this community. A quality indicator (QI) was developed based on PARA results. The average QI of the areas assessed was 1.3 ± 6.40 and the median 1 point, a considerably low score if compared to scores of public PARs across the city (13.6 ± 4.91 and 13 points). The urban regeneration necessary for hosting mega-sport events is frequently promoted as an opportunity to enhance PARs and therefore to improve health through physical activity (PA) participation. Findings indicate that the high number of elements that can discourage the use of these spaces may help explain the low level of PA during leisure time that has been previously reported of residents of the same neighborhood. Whether using the Olympic Games as catalyst or not, policies designed to encourage PA should focus also on the built environment.

To assess the physical characteristics of public spaces designed for sport/physical activity/leisure in Rio de Janeiro, Brazil, and their relationship to the socioeconomic indicators.Public spaces (n = 38) spread across the city were evaluated between December 2011 and January 2012 using the Physical Activity Resource Assessment (PARA) instrument. Based on PARA results, a Quality Indicator (QI) was prepared and the sample was grouped into "High QI" and "Low QI" using a k-means clustering algorithm. The association between QI and the local Social Development Index (SDI) was tested using a Chi-square test.The average QI was 13.6 ± 4.91 and the median was equal to 13 points. The High QI group, composed of sites with a QI above median, reached 17.9 ± 2.35 points, while the Low QI group reached 9.3 ± 2.16 points. Pearson's Chi-square tests identified a significant association between QI and SDI when the value of SDI 0.7 was used as a criterion for separation (χ(2) = 17.84, p0.001). In neighborhoods with lower levels of SDI, public spaces usually had a lower QI.Policies to encourage physical activity need to focus attention on the built environment also, particularly in socially vulnerable areas.