Efeitos dos programas de reabilitação na variabilidade da frequência cardíaca após acidente vascular cerebral: uma revisão sistemática

Belli, Thais Regina; Souza, Luciane Aparecida Pascucci Sande de; Bazan, Silméia Garcia Zanati; Bazan, Rodrigo; Luvizutto, Gustavo José

doi:10.1590/0004-282X-anp-2020-0420

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View and Review • Arq. Neuro-Psiquiatr. 79 (8) • Ago 2021 • https://doi.org/10.1590/0004-282X-anp-2020-0420 copiar

Efeitos dos programas de reabilitação na variabilidade da frequência cardíaca após acidente vascular cerebral: uma revisão sistemática

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Antecedentes:

O sistema nervoso autônomo pode ser modulado pelo exercício físico após o acidente vascular cerebral (AVC), mas faltam evidências que demonstrem que a reabilitação pode ser eficaz no aumento da variabilidade da frequência cardíaca (VFC).

Objetivo:

Investigar a eficácia e segurança dos programas de reabilitação na modulação da VFC após o AVC.

Métodos:

A estratégia de busca foi baseada na estratégia PICOT (pacientes: AVC; intervenções: reabilitação; comparações: qualquer grupo de controle; desfechos: VFC; tempo: fase aguda, subaguda e crônica). Foi realizada busca nas bases MEDLINE, CENTRAL, CINAHL, LILACS e SCIELO sem restrições de idioma, sendo incluídos ensaios clínicos randomizados (ECRs), ensaios clínicos quasi-randomizados (quasi-ECRs) e ensaios clínicos não-randomizados (não-ECRs). Dois autores avaliaram independentemente o risco de viés e a metodologia GRADE para classificar a certeza das evidências para cada estudo incluído.

Resultados:

Quatro estudos (dois ECRs com baixa certeza de evidência e dois não-ECRs com muito baixa certeza de evidência) foram incluídos. Três deles apresentaram modulação autonômica cardíaca durante e após a reabilitação: a razão LF/HF (low frequency/high frequency) foi maior durante a mobilização precoce; maior equilíbrio autonômico foi observado após prática de interação corpo-mente após AVC; e SDNN (desvio padrão dos intervalos R-R normais) foi significativamente menor em pacientes com AVC indicando menor adaptação autonômica cardíaca durante diferentes atividades.

Conclusões:

Não há conclusão definitivas sobre as principais repercussões cardíaca autonômica nos pacientes com AVC na reabilitação, embora todas as intervenções foram seguras para os pacientes após AVC.

Palavras-chave:
Acidente Vascular Cerebral; Variabilidade Cardíaca; Reabilitação; Fisioterapia

Author/Year	Study design	N/Age	Stroke time (days)	HRV variables
Nozoe et al., 20181515. Nozoe M, Yamamoto M, Kobayashi M, Kanai M, Kubo H, Shimada S, et al. Heart rate variability during early mobilization in patients with acute ischemic stroke. Eur Neurol. 2018;80(1-2):50-4. https://doi.org/10.1159/000492794 https://doi.org/10.1159/000492794...	Non-RCT	N = 21/71 y*	1 -10	LF, lnHF and LF/HF
Chen et al., 20192323. Chen CH, Hung KS, Chung YC, Yeh ML. Mind-body interactive qigong improves physical and mental aspects of quality of life in patients with stroke: a randomized control study. Eur J Cardiovasc Nurs. 2019 Dec;18(8):658-66. https://doi.org/10.1177/1474515119860232 https://doi.org/10.1177/1474515119860232...	RCT	N = 72/65 ( 13.5 y	1 -10	SDNN, LF, HF and LF/HF
Beer et al., 20182424. Beer NR, Soroker N, Bornstein N, Katz-Leurer M. The cardiac autonomic nervous system response to different daily demands among patients at the sub-acute phase post ischemic stroke and healthy controls. NeuroRehabilitation. 2018;42(4):391-6. https://doi.org/10.3233/NRE-172295 https://doi.org/10.3233/NRE-172295...	Non-RCT	N = 19/63 y*	Post-acute	SDNN and RMSSD
Katz-Leurer & Shochina, 20072222. Katz-Leurer M, Shochina M. The influence of autonomic impairment on aerobic exercise outcome in stroke patients. NeuroRehabilitation. 2007 Oct;22(4):267-72. https://doi.org/10.3233/NRE-2007-22403 https://doi.org/10.3233/NRE-2007-22403...	RCT	N = 64/62 ( 8.5 y	15	LF and HF

HRV	System evaluated
SDNN	Sympathetic and parasympathetic activity
RMSSD	Parasympathetic activity
LF	Sympathetic and parasympathetic activity
HF	Parasympathetic activity
InHF	Parasympathetic activity
LF/HF	Sympathetic and parasympathetic balance

Author (year)	Interventions	Results	GRADE
Nozoe et al., 20181515. Nozoe M, Yamamoto M, Kobayashi M, Kanai M, Kubo H, Shimada S, et al. Heart rate variability during early mobilization in patients with acute ischemic stroke. Eur Neurol. 2018;80(1-2):50-4. https://doi.org/10.1159/000492794 https://doi.org/10.1159/000492794...	Early mobilization in the ND group (n = 7) and early mobilization in the non-ND group (n = 14)	LF/HF is higher in patients with ND during early mobilization; suggests increase in sympathetic activity	⊕ Very Low
Chen et al., 20192323. Chen CH, Hung KS, Chung YC, Yeh ML. Mind-body interactive qigong improves physical and mental aspects of quality of life in patients with stroke: a randomized control study. Eur J Cardiovasc Nurs. 2019 Dec;18(8):658-66. https://doi.org/10.1177/1474515119860232 https://doi.org/10.1177/1474515119860232...	Mind-body interactive exercise - Chan-Chuang qigong practice (15 minutes/day) (n = 36) and control group (n = 36)	LF/HF ratio significantly influenced the physical component of quality of life; suggests cardiac autonomic balance after intervention	⊕⊕ Low
Beer et al., 20182424. Beer NR, Soroker N, Bornstein N, Katz-Leurer M. The cardiac autonomic nervous system response to different daily demands among patients at the sub-acute phase post ischemic stroke and healthy controls. NeuroRehabilitation. 2018;42(4):391-6. https://doi.org/10.3233/NRE-172295 https://doi.org/10.3233/NRE-172295...	Static and dynamic exercises; dual task; breathing exercise for 2 minutes.	Resting SDNN was significantly lower among post-stroke patients compared with healthy individuals; less adaptive cardiac autonomic control during different activities	⊕ Very Low
Katz-Leurer & Shochina, 20072222. Katz-Leurer M, Shochina M. The influence of autonomic impairment on aerobic exercise outcome in stroke patients. NeuroRehabilitation. 2007 Oct;22(4):267-72. https://doi.org/10.3233/NRE-2007-22403 https://doi.org/10.3233/NRE-2007-22403...	Conventional physical therapy	No alterations in HRV	⊕⊕ Low

Risk of bias	High Risk	Low Risk	Uncertain Risk
Random sequence generation	Beer et al., 20182424. Beer NR, Soroker N, Bornstein N, Katz-Leurer M. The cardiac autonomic nervous system response to different daily demands among patients at the sub-acute phase post ischemic stroke and healthy controls. NeuroRehabilitation. 2018;42(4):391-6. https://doi.org/10.3233/NRE-172295 https://doi.org/10.3233/NRE-172295... ; Nozoe et al., 20181515. Nozoe M, Yamamoto M, Kobayashi M, Kanai M, Kubo H, Shimada S, et al. Heart rate variability during early mobilization in patients with acute ischemic stroke. Eur Neurol. 2018;80(1-2):50-4. https://doi.org/10.1159/000492794 https://doi.org/10.1159/000492794...	Chen et al., 20192323. Chen CH, Hung KS, Chung YC, Yeh ML. Mind-body interactive qigong improves physical and mental aspects of quality of life in patients with stroke: a randomized control study. Eur J Cardiovasc Nurs. 2019 Dec;18(8):658-66. https://doi.org/10.1177/1474515119860232 https://doi.org/10.1177/1474515119860232... ; Katz-Leurer; Shochina, 20072222. Katz-Leurer M, Shochina M. The influence of autonomic impairment on aerobic exercise outcome in stroke patients. NeuroRehabilitation. 2007 Oct;22(4):267-72. https://doi.org/10.3233/NRE-2007-22403 https://doi.org/10.3233/NRE-2007-22403...	None
Allocation concealment	Beer et al., 20182424. Beer NR, Soroker N, Bornstein N, Katz-Leurer M. The cardiac autonomic nervous system response to different daily demands among patients at the sub-acute phase post ischemic stroke and healthy controls. NeuroRehabilitation. 2018;42(4):391-6. https://doi.org/10.3233/NRE-172295 https://doi.org/10.3233/NRE-172295... ; Nozoe et al., 20181515. Nozoe M, Yamamoto M, Kobayashi M, Kanai M, Kubo H, Shimada S, et al. Heart rate variability during early mobilization in patients with acute ischemic stroke. Eur Neurol. 2018;80(1-2):50-4. https://doi.org/10.1159/000492794 https://doi.org/10.1159/000492794...	Chen et al., 20192323. Chen CH, Hung KS, Chung YC, Yeh ML. Mind-body interactive qigong improves physical and mental aspects of quality of life in patients with stroke: a randomized control study. Eur J Cardiovasc Nurs. 2019 Dec;18(8):658-66. https://doi.org/10.1177/1474515119860232 https://doi.org/10.1177/1474515119860232...	Katz-Leurer; Shochina, 20072222. Katz-Leurer M, Shochina M. The influence of autonomic impairment on aerobic exercise outcome in stroke patients. NeuroRehabilitation. 2007 Oct;22(4):267-72. https://doi.org/10.3233/NRE-2007-22403 https://doi.org/10.3233/NRE-2007-22403...
Blinding of the participants	Chen et al., 20192323. Chen CH, Hung KS, Chung YC, Yeh ML. Mind-body interactive qigong improves physical and mental aspects of quality of life in patients with stroke: a randomized control study. Eur J Cardiovasc Nurs. 2019 Dec;18(8):658-66. https://doi.org/10.1177/1474515119860232 https://doi.org/10.1177/1474515119860232...	None	Katz-Leurer; Shochina, 20072222. Katz-Leurer M, Shochina M. The influence of autonomic impairment on aerobic exercise outcome in stroke patients. NeuroRehabilitation. 2007 Oct;22(4):267-72. https://doi.org/10.3233/NRE-2007-22403 https://doi.org/10.3233/NRE-2007-22403... Beer et al., 20182424. Beer NR, Soroker N, Bornstein N, Katz-Leurer M. The cardiac autonomic nervous system response to different daily demands among patients at the sub-acute phase post ischemic stroke and healthy controls. NeuroRehabilitation. 2018;42(4):391-6. https://doi.org/10.3233/NRE-172295 https://doi.org/10.3233/NRE-172295... ; Nozoe et al., 20181515. Nozoe M, Yamamoto M, Kobayashi M, Kanai M, Kubo H, Shimada S, et al. Heart rate variability during early mobilization in patients with acute ischemic stroke. Eur Neurol. 2018;80(1-2):50-4. https://doi.org/10.1159/000492794 https://doi.org/10.1159/000492794...
Blinding of the outcome assessment	Chen et al., 20192323. Chen CH, Hung KS, Chung YC, Yeh ML. Mind-body interactive qigong improves physical and mental aspects of quality of life in patients with stroke: a randomized control study. Eur J Cardiovasc Nurs. 2019 Dec;18(8):658-66. https://doi.org/10.1177/1474515119860232 https://doi.org/10.1177/1474515119860232...	None	Katz-Leurer; Shochina, 20072222. Katz-Leurer M, Shochina M. The influence of autonomic impairment on aerobic exercise outcome in stroke patients. NeuroRehabilitation. 2007 Oct;22(4):267-72. https://doi.org/10.3233/NRE-2007-22403 https://doi.org/10.3233/NRE-2007-22403... Beer et al., 20182424. Beer NR, Soroker N, Bornstein N, Katz-Leurer M. The cardiac autonomic nervous system response to different daily demands among patients at the sub-acute phase post ischemic stroke and healthy controls. NeuroRehabilitation. 2018;42(4):391-6. https://doi.org/10.3233/NRE-172295 https://doi.org/10.3233/NRE-172295... ^; Nozoe et al., 20181515. Nozoe M, Yamamoto M, Kobayashi M, Kanai M, Kubo H, Shimada S, et al. Heart rate variability during early mobilization in patients with acute ischemic stroke. Eur Neurol. 2018;80(1-2):50-4. https://doi.org/10.1159/000492794 https://doi.org/10.1159/000492794...
Incomplete outcome data	Beer et al., 20182424. Beer NR, Soroker N, Bornstein N, Katz-Leurer M. The cardiac autonomic nervous system response to different daily demands among patients at the sub-acute phase post ischemic stroke and healthy controls. NeuroRehabilitation. 2018;42(4):391-6. https://doi.org/10.3233/NRE-172295 https://doi.org/10.3233/NRE-172295... ; Nozoe et al., 20181515. Nozoe M, Yamamoto M, Kobayashi M, Kanai M, Kubo H, Shimada S, et al. Heart rate variability during early mobilization in patients with acute ischemic stroke. Eur Neurol. 2018;80(1-2):50-4. https://doi.org/10.1159/000492794 https://doi.org/10.1159/000492794...	Chen et al., 20192323. Chen CH, Hung KS, Chung YC, Yeh ML. Mind-body interactive qigong improves physical and mental aspects of quality of life in patients with stroke: a randomized control study. Eur J Cardiovasc Nurs. 2019 Dec;18(8):658-66. https://doi.org/10.1177/1474515119860232 https://doi.org/10.1177/1474515119860232...	Katz-Leurer; Shochina, 20072222. Katz-Leurer M, Shochina M. The influence of autonomic impairment on aerobic exercise outcome in stroke patients. NeuroRehabilitation. 2007 Oct;22(4):267-72. https://doi.org/10.3233/NRE-2007-22403 https://doi.org/10.3233/NRE-2007-22403...
Selective outcome reporting	None	Chen et al., 20192323. Chen CH, Hung KS, Chung YC, Yeh ML. Mind-body interactive qigong improves physical and mental aspects of quality of life in patients with stroke: a randomized control study. Eur J Cardiovasc Nurs. 2019 Dec;18(8):658-66. https://doi.org/10.1177/1474515119860232 https://doi.org/10.1177/1474515119860232...	Katz-Leurer; Shochina, 20072222. Katz-Leurer M, Shochina M. The influence of autonomic impairment on aerobic exercise outcome in stroke patients. NeuroRehabilitation. 2007 Oct;22(4):267-72. https://doi.org/10.3233/NRE-2007-22403 https://doi.org/10.3233/NRE-2007-22403... Beer et al., 20182424. Beer NR, Soroker N, Bornstein N, Katz-Leurer M. The cardiac autonomic nervous system response to different daily demands among patients at the sub-acute phase post ischemic stroke and healthy controls. NeuroRehabilitation. 2018;42(4):391-6. https://doi.org/10.3233/NRE-172295 https://doi.org/10.3233/NRE-172295... ; Nozoe et al., 20181515. Nozoe M, Yamamoto M, Kobayashi M, Kanai M, Kubo H, Shimada S, et al. Heart rate variability during early mobilization in patients with acute ischemic stroke. Eur Neurol. 2018;80(1-2):50-4. https://doi.org/10.1159/000492794 https://doi.org/10.1159/000492794...

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[1] Correspondence:

Gustavo José Luvizutto; E-mail: gluvizutto@gmail.com