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Publication
Exercício Físico Na Insuficiência Cardíaca Congestiva Em Cães
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Advisor(s)
Abstract(s)
A utilidade do exercício físico na insuficiência cardíaca congestiva não é ainda bem conhecida na área da cardiologia veterinária, apesar de muitos estudos já publicados, ao contrário da medicina humana, onde os benefícios e a segurança do exercício físico foram amplamente comprovados, estando incluído nas recomendações e consensos de tratamento. Vários estudos foram realizados desde o fim do século XX, avaliando a utilidade do exercício físico no diagnóstico, prognóstico e avaliação da resposta aos medicamentos utilizados na insuficiência cardíaca congestiva em cães. As informações desses estudos foram compiladas neste trabalho com o objectivo de realizar uma revisão bibliográfica sobre este tema e propor uma base de trabalho, informações e protocolos para desenvolver o conhecimento sobre o efeito do exercício físico na insuficiência cardíaca congestiva em cães para futuras pesquisas clínicas. Foram publicados dois grandes tipos de testes: o teste de caminhada de seis minutos, de fácil implementação e que parece refletir mais as capacidades físicas quotidianas dos cães doentes e os testes em passadeira, como o teste ergométrico ou os testes incrementais que, combinados com a medição da concentração plasmática do NT-proBNP parecem promissores para a avaliação prognóstica e o acompanhamento da terapia medicamentosa convencional. O exercício físico não reverte os danos provocados pela insuficiência cardíaca congestiva, mas pode ajudar a adiar e abrandar a evolução da doença, tendo essencialmente efeitos sobre a frequência cardíaca e a modulação da atividade simpática preservando a função cardíaca. Além disso, foi constatada uma melhoria da classe funcional de ICC (insuficiência cardíaca congestiva) (classificação da NYHA modificada para uso veterinário) e da qualidade de vida devido ao exercício físico, o que é um ponto fundamental para os tutores. Mesmo considerando os riscos desta terapia complementar (síncopes ou risco de agravar os sintomas das patologias cardíacas), o balanço risco-benefício parece claramente favorecer a utilização do exercício físico quando utilizado de forma controlada. Evidências da utilidade do exercício físico como método de teste ou como tratamento complementar ao medicamentoso existem atualmente e foram recolhidas nesta revisão. No entanto, para desenvolver mais a prática clínica do exercício, outros estudos precisam ser realizados para desenvolver métodos de testes padronizados, esclarecer o impacto do exercício sobre todas as classes da insuficiência cardíaca, avaliar os riscos e analisar os efeitos deste a longo prazo na espécie canina.
The utility of physical exercise in congestive heart failure is not yet well known in the field of veterinary cardiology, despite many studies already published, unlike in human medicine where the benefits and safety of physical exercise have been widely proven and included in recommendations and consensus. Several studies have been conducted since the end of the 20th century, evaluating the usefulness of physical exercise in the diagnosis, prognosis as well as in the assessment of the response to medical treatment of congestive heart failure in dogs. The information from these studies has been compiled in this work to conduct a literature review on this topic and propose a work base, information, and protocols to develop knowledge about the effect of physical exercise on congestive heart failure for future clinical research in dogs. Two major types of tests have been published: the 6-minute walk test, easy to implement and seemingly better at reflecting the daily physical capacities of cardiac dogs; and treadmill tests, such as the ergometric test or incremental tests which, combined with the measurement of plasma concentration of NT-proBNP, promising for prognostic evaluation and monitoring of conventional drug therapy. Physical exercise does not reverse the damage caused by congestive heart failure but can help delay and slow the progression of the disease, essentially having effects on heart rate and sympathetic modulation of cardiac activity and preserving cardiac function. Additionally, an improvement in functional class (NYHA classification modified for veterinary use) of CHF (cardiac heart failure) and quality of life due to physical exercise has been observed, which is a key point for owners. Even though there are risks associated with this complementary therapy (syncope or risk of exacerbating symptoms of cardiac pathologies), the risk-benefit balance seems to clearly favour the use of exercise when used in a controlled manner. Evidence of the utility of physical exercise as a testing method or as a complementary treatment to pharmacological treatments currently available and has been gathered in this review. However, to further develop the clinical practice of exercise, additional studies need to be conducted to develop standardized testing methods, clarify the impact of exercise on all classes of heart failure, assess the risks and analyse the long-term effects on canine species.
The utility of physical exercise in congestive heart failure is not yet well known in the field of veterinary cardiology, despite many studies already published, unlike in human medicine where the benefits and safety of physical exercise have been widely proven and included in recommendations and consensus. Several studies have been conducted since the end of the 20th century, evaluating the usefulness of physical exercise in the diagnosis, prognosis as well as in the assessment of the response to medical treatment of congestive heart failure in dogs. The information from these studies has been compiled in this work to conduct a literature review on this topic and propose a work base, information, and protocols to develop knowledge about the effect of physical exercise on congestive heart failure for future clinical research in dogs. Two major types of tests have been published: the 6-minute walk test, easy to implement and seemingly better at reflecting the daily physical capacities of cardiac dogs; and treadmill tests, such as the ergometric test or incremental tests which, combined with the measurement of plasma concentration of NT-proBNP, promising for prognostic evaluation and monitoring of conventional drug therapy. Physical exercise does not reverse the damage caused by congestive heart failure but can help delay and slow the progression of the disease, essentially having effects on heart rate and sympathetic modulation of cardiac activity and preserving cardiac function. Additionally, an improvement in functional class (NYHA classification modified for veterinary use) of CHF (cardiac heart failure) and quality of life due to physical exercise has been observed, which is a key point for owners. Even though there are risks associated with this complementary therapy (syncope or risk of exacerbating symptoms of cardiac pathologies), the risk-benefit balance seems to clearly favour the use of exercise when used in a controlled manner. Evidence of the utility of physical exercise as a testing method or as a complementary treatment to pharmacological treatments currently available and has been gathered in this review. However, to further develop the clinical practice of exercise, additional studies need to be conducted to develop standardized testing methods, clarify the impact of exercise on all classes of heart failure, assess the risks and analyse the long-term effects on canine species.
Description
Keywords
Cães Insuficiência Cardíaca Congestiva Terapia Complementar Teste De Exercício Treino Físico Dogs Congestive Heart Failure Complementary Therapy Exercise Testing Physical Training