Expertos Invitados





REABILITAÇAO NAO SUPERVISIONADA: UM PROCEDIMENTO SEGURO, UTIL E SIMPLES

(especial para SIIC © Derechos reservados)
É realçada a importância da execução do programa por equipe multiprofissional, cabendo ao médico dirigir o treinamento, diagnosticar, solicitar exames, prescrever terapêutica e dar alta aos pacientes
filho9.jpg Autor:
Japy angelini Oliveira filho
Columnista Experto de SIIC

Institución:
Disciplina de Cardiologia Departamento de Medicina Escola Paulista de Medicina Universidade Federal de São Paulo SP, Brasil

Artículos publicados por Japy angelini Oliveira filho
Coautores
Ana Cristina Monteiro Leal* Xiomara Miranda Salvetti** Dirceu Vieira Santos Filho*** Valter Correia de Lima**** Bráulio Luna Filho***** 
Pós-graduando em Cardiologia (nível de Mestrado) UNIFESP-EPM.*
Mestre em Cardiologia pela UNIFESP-EPM; Pós-graduando.em Medicina em nível de Doutorado, Bolsista do Conselho Nacional de Pesquisas UNIFESP-EPM.**
(in memoriam Santos Filho Professor Adjunto.UNIFESP-EPM.***
Professor Adjunto Livre-Docente UNIFESP- EPM.****
Professor Livre Docente em Medicina UNIFESP-EPM.*****
Recepción del artículo
20 de Abril, 2004 		Aprobación
10 de Agosto, 2004
Primera edición
2 de Diciembre, 2004 		Segunda edición, ampliada y corregida
7 de Junio, 2021

REABILITAÇAO NAO SUPERVISIONADA: UM PROCEDIMENTO SEGURO, UTIL E SIMPLES

Resumen
Os autores analisam a reabilitação não supervisionada (RNS), exclusividade de pacientes coronários de baixo risco (Classe B, Sociedade Brasileira de Cardiologia). Até 2004 registravam-se 22 relatos (1895 pacientes). Atribui-se à RNS risco de 1/70000 paradas cardiocirculatórias / pacientes horas exercitados. Embora pré-requisito para RNS (S.B.C., A.H.A.), o treinamento supervisionado, tem sido substituído por consultas e demonstrações práticas. RNS é destinada a pacientes com conhecimento dos princípios do treinamento, habilidade para aferição da freqüência cardiaca, boa aderência, aceitação incondicional da prescrição e auto-disciplina. Descrevem-se os critérios de inclusão, os protocolos e a prescrição do exercício, com intensidade de 40 a 60% do VO2 pico (58 a 72% da freqüência cardiaca de pico). Listam-se os cuidados gerais. Discutem-se os esportes recreativos e o horário ideal para treinamento. Conclui-se que, em geral, os pacientes devem exercitar-se no horário mais adequado às suas possibilidades. É realçada a importância da equipe multiprofissional, cabendo ao médico dirigir o treinamento, diagnosticar, solicitar exames, prescrever terapêutica e dar alta aos pacientes (Conselho Federal de Medicina, Resolução nº 1236/87).

Palabras clave
Exercício, Teste ergométrico, Reabilitação cardíaca, Doença coronária


Artículo completo
(castellano)
Extensión:  +/-8.19 páginas impresas en papel A4
Exclusivo para suscriptores/assinantes

Abstract
The authors discuss the non-supervised rehabilitation (NSR), an usefull, safety, home-based procedure for low risk coronary patients (Class B, Brazilian Society of Cardiology). They founded 22 NSR manuscripts, including 1895 patients.The cardiac arrest risk was 1 / 70000 events per person-hours exercised. The previous supervised training is considered an essential inclusion critery (Brazilian Society of Cardiology, American Heart Association). Recently, it has been replaced by instruction interviews. The NRS is destinated for patients who demonstrate knowledge of the training principles, hability to control heart rate, and a high likehood of compliance to prescription. It is related the inclusion criteria, the exercise prescription ( intensity training at 40 to 60% of Peak VO2 - 58 to 72% of peak heart rate), the daily cautions, and the elegibility to sports. The patients should exercise, generally, in the more suitable schedule.The program is executed by a trained multiprofessional team. Nevertheless, the doctor is the responsible subject to manage the training, to ask examinations, to make therapeutic prescriptions, and to discharge the patients ( Federal Council of Medicine, Resolution 1236/87).

Key words
Exertion, Exercise testing, Home-based rehabilitation, Coronary heart disease

Clasificación en siicsalud
Artículos originales > Expertos de Iberoamérica >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Cardiología, Fisiatría
Relacionadas: Medicina Deportiva, Medicina Interna



Comprar este artículo
Extensión: 8.19 páginas impresas en papel A4

file05.gif (1491 bytes) Artículos seleccionados para su compra



Enviar correspondencia a:
Japy Angelini Oliveira Filho, Universidade Federal de São Paulo Escola Paulista de Medicina, 05594-050, Rua Tapejara 109, São Paulo, Brasil
Bibliografía del artículo
  1. Fletcher GF, Balady GJ, Amsterdam EA et al. AHA Scientific Statement. Exercise standards for exercise and training. Circulation 2001 ; 104:1694-1740.
  2. Oliveira F, JA & Salvetti ,XM .Programas não supervisionados em reabilitação cardiovascular. Abordagem da prescrição dos exercícios. Rev SOCESP 1996; 6:31-9.
  3. Oliveira F, JA. Prescrição de exercícios físicos em cardiopatas. IN: Borges DR & Rothshield H. Atualização Terapêutica. 20a ed. São Paulo, Artes Médicas, 2001. pg. 60-63.
  4. Carlson JJ, Johnson JA, Franklin BA, VanderLaan RL. Program participation, exercise adherence, cardiovascular outcomes, and program cost of traditional versus modified cardiac rehabilitation. Am J Cardiol 2000 ; 86:17-23.
  5. Arthur HM, Smith KM, Kodis J, McKelvie R. A controlled trial of hospital versus home-based exercise in cardiac patients. Med Sci Sports Exer 2002; 34:1544-1550.
  6. Balady JG, Fletcher BJ, Froelicher VF et al. AHA Medical/ Scientific Statement: Position statement: Cardiac rehabilitation programs: a statement for health care professionals from AHA. Circulation 1994; 90:1602-1610.
  7. Brubaker PH, Rejeski J, Smith MJ, Sevenski KH, Lamb KA, Sotile WM, Miller Jr HS. A home-based maintenance exercise program after center-based cardiac rehabilitation: effects on blood lipids, body composition, and functional capacity. J Cardiopulmonary Rehabil 2000; 20: 50-56.
  8. Wenger NK. Modern coronary rehabilitation. Postgrad Med 1993; 94:131-6.
  9. Epstein SE, Palmeri ST, Patterson RE. Evaluation of patients after acute myocardial infarction. Indications for cardiac catheterization and surgical intervention. N Engl J Med 1982; 307:1487-1492.
  10. Williams RS, Miller H, Koisch P et al. Guidelines for unsupervised exercise in patients with ischemic heart disease. J Card Rehab 1981; 1: 213-9.
  11. Godoy M, Bellni AJ, Pássaro LE et al. I Consenso Nacional de Reabilitação Cardiovascular. Sociedade Brasileira de Cardiologia. Departamento de Ergometria e Reabilitação. Arq Bras Cardiol 1997; 69: 267- 292.
  12. Miller NH, Haskell WL, Berra K De Busk RF. Home versus group exercise training for increasing functional capacity after myocardial infarction. Circulation 1984 ;70:645-9.
  13. Kugler J, Dimsdale JE, Hartley H, Sherwood J. Hospital supervised vs home exercise in cardiac rehabilitation: effects on aerobic fitness, anxiety, and depression. Arch Phys Med Rehabil 1990;71:322-325.
  14. Ueshima K, Saito M, Shimohara A, et al. Management and evaluation of non-supervised home exercise program in convalescent phase of acute myocardial infarction. Jap Circulation J 1990; 54:1437-1440.
  15. Thomas RJ, Miller NH, Taylor CB, Ghandour G, Fisher L, DeBusk RF. Nurse-managed Home-Based exercise training after acute myocardial infarction: methods and effects on functional capacity. Circulation 1991; 84 (Suppl II):540.
  16. Shimohara A, Ueshima K, Saito M et al. Non-supervised home exercise programs in a convalescent phase of acute myocardial infarction: their effectiveness and usefulness of the heart rate at anaerobic threshold. J Cardiol 1991; 21;309-315.
  17. Giannuzzi P, Tavazzi L, Temporelli PL et al. Long-term physical training and left ventricular remodeling after anterior myocardial infarction: results of the exercise in EAMI trial . JACC 1993 22:1821-9.
  18. Aros F, Armentia J, Castillo C, Cordo JC, Loma-Osorio A precozión Del entrenamiento físico domiciliario precoz despus de un infarto agudo de miocardio. Rev Esp Cardiol 1993; 46:544-41.
  19. Sparks KE, Shaw DK, Eddy, D Hanigosky P, Vantrese J. Alternatives for cardiac rehabilitation patients unable to return to a hospital-based program. Heart & Lung 1993; 22:298-303.
  20. Fletcher BJ, Dunbar SB, Felner JM, Jensen BE, Almon L, Cotsonis G, Fletcher GF. Exercise testing and training in physically disabled men with clinical evidence of coronary artery disease. Am J Cardiol 1994;73:170-4.
  21. Froelicher ES, Kee LL, Newton KM, Lindskog B, Livingston M. Return to work, sexual activity and other activities after acute myocardial infarction. Heart Lung 1994; 23:423-35.
  22. Brosseau R, Juneau M, Sirard A, Savard A, Marchand C, Boudreau MH, Bradley S, Bleau L. Can J Cardiol 1995 ;11:675-685.
  23. Adachi H, Koike A, Obayashi T, et al. Appropriate endurance exercise training improve cardiac function in patients with prior myocardial infarction Europ Heart J 1996; 17:1511-1521.
  24. Bjarnason-Wehrens B, Predel HG, Graf C, Gunter D, Rost R. Improvement of physical performance and aerobic capacity mediated by a novel 4-week ambulatory cardiac rehabilitation program. Z Cardiol 1999; 88:113-22.
  25. Kodis J,Smith KM, Arthur HM,Daniels C, Sukin N, McKelvie RS. Changes in exercise capacity and lipid after clinic versus home-based aerobic training in coronary artery bypass graft surgery patients. J Cardiopulmonar Reahabil 2001; 21:31-6.
  26. Fugiwara M, Asamuka S, Iwasaki T. Long term effects of non supervised home exercise therapy on quality of life in patients with myocardial infartion. J cardiol 2000 36:213-9.
  27. Iellano F, Legramante JM, Massaro M, Raimondi G, Galante A. Effects of residential exercise training on baroreflex sesitivity and heart variability in patientes with coronary artery disease. Circulation 2000; 2588-92.
  28. Ades PA, Pashkow FJ, Fletcher G, Pina IL, Zohman LR, Nestor JR. A controlled trial of cardiac rehabilitation in the home setting using electrocardiographic and voice transtelephonic monitoring. Am Heart J 2000 ; 139:543-8.
  29. Oliveira F JA, Leal AC, Salles AF, Mesquita F, Leite W, Santos F DV. Reabilitação não supervisionada em consultório. Arq Bras Cardiol 1999; 73 (Suppl 6):57.
  30. Oliveira F JA, Leal AC, Lima VC, Santos F DV, Luna F B. Reabilitação não supervisionada: efeitos de treinamento ambulatorial a longo prazo. Arq Bras Cardiol 2002; 79;233-238.
  31. Yazbek Jr P, Santomauro AC, Wajngarten M, Azul LGS, Battistella LR, Pilleggi F. Exercício não supervisionado para cardiopatas – imperativos. Arq Bras Cardiol 1993; 60:51-52.
  32. Nogueira IDB, Pulz C, Salvetti XM, Perez PAT, Carvalho ACC, Oliveira F JA. Modelo para ficha de orientação e avaliação da aderência a um programa de reabilitação cardíaca não supervisionada. Arq Bras Cardiol 2002; 79 (supl III):243
  33. Rost R. A atividade física e o coração. Rio de Janeiro, MEDSI, 1991.
  34. Hellerstein HK & Franklin BA. Exercise testing and prescription. IN: Wenger NK & Hellerstein HK ed Rehabilitation of the coronary patient. New York, John Wiley & Sons, 1978.
  35. Wasserman et al. Principles of exercise testing and interpretation. Philadelphia, Lea & Febiger, 1994. 2 ed. Pg. 121.
  36. Ridker PM, Manson JE, Buring J E et al Circadian variation of acute myocardial infarction and the effect of a low-dose aspirin in a randomised trial of physicians. Circulation 1990; 82:897-902.
  37. Haskell WL. Design and implementation of cardiac conditioning programs. IN: Wenger NK e Hellerstein HK ed. Rehabilitation of the coronary patient. New York, John Wiley & Sons, 1978.
  38. Oliveira F JA & Salvetti XM. O papel da reabilitação não supervisionada. Rev SOCESP 2003; 13:214-225.
  39. Oliveira F JA & Salvetti XM. Reabilitação não supervisionada ou semi-supervisionada: uma alternativa válida.Manuscrito enviado para apreciação aos Arq. Bras. Cardiol.
  40. Mitchell JH, Haskell WL, Raven PB. Classification of Sports. Med Sc Sport Exer 1994; 26 (sup):242-5.
  41. Goepfert PC, Chignon JC. Reabilitação cardiovascular. São Paulo, MEDSI, 1988.
  42. Vivolo MA, Ferreira SRG, Hidal JT. Execício físico e diabete melito. Rev SOCESP 1996; 6:102-110.
  43. Hough DO. Diabetes mellitus nos desportos. Clin Med Am Norte 1994; 2:439-454.
  44. Pells D'Alonzo CA. Acute myocardial infarction in large industrial population: report of a 6 year study of 1356 cases. JAMA 1963; 185: 831-8.
  45. Zornoza J, Smith M, Lihle W. Effect of activities on circadian variation in time of onset of acute myocardial infarction. Am J Cardiol 1992; 69:1089-92.
  46. Muller JE, Geoffrey H, Toffer MB et al. Circadian variation and triggers of onset acute cardiovascular disease. Circulation 1989;79:733-41.
  47. Cannon CP, McCabe CH, Stone PH et al. Circadian variation in the onset of usntable angina and non-Q-wave acute myocardial infarction (the TIMI III Registry and TIMI IIIB). Am J Cardiol 1997; 79:253-8.
  48. Nagashima M, Uchida T, Tanaka M et al. Comparison of the circadian variation of the time of the onset of acute myocardial infarction and of attack of vasospastic angina without significant stenosis. J Cardiol 2000; 36:1-7.
  49. Sayer JW, Wilkinson P, Ranjadayalan K, Ray S, Marchant B, Timmis AD. Attenuation or absence of circadian and seasonal rhythms of acute myocardial infarction. Heart 1997; 77:325-9.
  50. Kinjo K, Sato H, Sato h et al. Circadian variation of the onset of acute myocardial infarction in Osaka área, 1998-1999: characterization of morning and nighttime peaks. Jpn Circ J 2001: 65:617-20.
  51. Trappolini M, Matteoli S, Borgia MC, Rinaldi R, Chilotti FM, Trappolini F, Del Vecchio RL, Puletti M. Variazone circadiana dell'insorgenza dell'infarto miocardico aguto. Minerva Cardioangiol 2001; 49: 289-96.
  52. Hyalmarson A, Gilpin EA, Nicod P et al. Differing circadian patlerns of onset in sub groups of patients with myocardial infarction. Circulation, 1984; 80: 267-75.
  53. Hansen O, Bengt J, Gullberj B. Circadian distribution of onset of myocardial infarction in subgroup from analysis of 10,791 patients treated in a single center. Am J Cardiol 1992;69: 1003-8.
Título español
Resumen
 Palabras clave
 Bibliografía
 Artículo completo
(exclusivo a suscriptores)
 Autoevaluación
  Tema principal en SIIC Data Bases
 Especialidades

  English title
 Abstract
 Key words
Full text
(exclusivo a suscriptores)

Autor 
Artículos
Correspondencia
Patrocinio y reconocimiento
Imprimir esta página
 
 
 
 
 
 
 
 
 
 
 
 
Está expresamente prohibida la redistribución y la redifusión de todo o parte de los contenidos de la Sociedad Iberoamericana de Información Científica (SIIC) S.A. sin previo y expreso consentimiento de SIIC.
ua31618
Home

Copyright siicsalud © 1997-2024 ISSN siicsalud: 1667-9008