Banca de QUALIFICAÇÃO: NATÁLIA LOPES CARDOSO

Uma banca de QUALIFICAÇÃO de DOUTORADO foi cadastrada pelo programa.
STUDENT : NATÁLIA LOPES CARDOSO
DATE: 08/12/2025
TIME: 09:00
LOCAL: Departamento de Fisioterapia
TITLE:

Functional Assessment and Physical Training in Pulmonary Hypertension:
Evidence from Observational Studies and a Systematic Review of the
Overview Type

 

KEY WORDS:

Pulmonary Hypertension; Sistematic review; Validation study

PAGES: 120
BIG AREA: Ciências da Saúde
AREA: Fisioterapia e Terapia Ocupacional
SUMMARY:

Introduction: Pulmonary hypertension (PH) is a progressive clinical condition
characterized by symptoms of dyspnea on exertion, exercise intolerance, and
reduced quality of life. Functional assessment in this population still lacks
more accessible and applicable instruments for clinical practice, and there are
also uncertainties about the superiority between different modalities of
physical training in this population. Objective: Study 1) To evaluate the
psychometric properties of validity, reliability, and feasibility of the 1-minute
sit-to-stand test (1-STST) in PH. Study 2) To evaluate and compare the
microcirculatory response based on peripheral tissue oxygenation and
electrical activity of peripheral muscles during functional tests in PH versus
controls. Study 3) To synthesize the evidence of physical rehabilitation
interventions in PH. Methodology: Study 1) Multicenter observational study
(Brazil - Spain), with adults with PH types I and IV. We evaluated pulmonary
function, quality of life, distance covered in the six-minute walk test (6MWT)
and the number of repetitions in the 1-STST. The validity between the 6MWT
and the 1-STST, the intra- and inter-rater reliability, and the feasibility of the 1-
STST for the team and population were observed. Study 2) Observational
study with adult individuals with PH types I and IV versus sex- and age-
matched controls. Pulmonary function, quality of life, the 6MWT and the 1-
STST were evaluated. Peripheral tissue oxygenation was assessed by NIRS,
using data on oxyhemoglobin (O₂Hb), deoxyhemoglobin (HHb), total
hemoglobin (tHb), hemoglobin difference (HbDiff), and tissue saturation index
(TSI), and muscle electrical activity was assessed by surface
electromyography (EMG) during the functional tests. Study 3) Overview of
systematic reviews (SRs) of randomized controlled trials in adults with PH
who underwent an exercise rehabilitation intervention, including physical
training (PT), inspiratory muscle training (IMT), or combined training (CT).
Seven databases were used, with a search strategy based on the PICOT
framework. Titles, abstracts, and full texts were analyzed by two independent
reviewers, and in case of disagreement, by a third reviewer. Methodological
quality and certainty of evidence were assessed using the AMSTAR-2 and
GRADE instruments, along with overlap analysis. Results: Study 1) Fifty
individuals with PH were included, 42 of whom were women, with a median
age of 48 years [38-68]. A moderate correlation was observed between the
6MWT and 1-STST tests (r = 0.53; p < 0.001) and acceptable agreement
using the Bland-Altman method (13%). Intra- and inter-rater reliability for 21
individuals was excellent, 0.93 (0.84-0.97) and 0.94 (0.85-0.97), respectively, with a standard error of measurement <10% and a minimum detectable
change of approximately six repetitions. The 1-STST proved feasible,
considered safer for staff and patients, while inducing less oxygen
desaturation at the end of the protocol (p = 0.01). Study 2) This study
included 18 female patients diagnosed with PH (83.3% type I) and 18
participants in the control group, with a mean age of 45.7 ± 15.0 and 45.0 ±
15.3 years and BMI of 25.7 ± 5.0 and 24.8 ± 3.6 kg/m2, respectively, with no
statistical differences. We observed statistically significant differences
between the groups in all pulmonary function variables, performance on
functional tests, and peripheral oxygen saturation, with p<0.05. In the NIRS
analysis, significant intergroup differences were identified in O₂Hb and HbDiff
in both functional tests between the PH group and controls, with p<0.05.
Electromyographic analysis is still underway. Study 3) 14 SRs were included,
divided into 6 in the PT group, 2 in the IMT group, and 6 in the CT group. All
three groups showed improvement in exercise capacity as measured by the
6MWT >48.5 m (PT), 39.1 m (IMT), and 49.5 m (CT). Peak VO₂ improved in
the PT and CT groups by >2.07 and >3.0 mL/kg/min, respectively. The
evaluation of IMT results was analyzed only in the group that performed it in
isolation, with maximum inspiratory pressure (>21.2 cmH₂O) and maximum
expiratory pressure (>14.4 cmH₂O). However, most studies were critically
considered to have low methodological quality and high overlap. Conclusion:
For the population with PH, especially groups I and IV, the 1-STST proved to
be valid, reliable, and feasible for functional monitoring, constituting a
practical and quick-to-perform tool suitable for clinical follow-up. Furthermore,
the microcirculatory response of the 1-STST was similar to that observed in
the 6MWT when compared to healthy individuals, reinforcing its applicability.
Finally, combined physical training appears to be the most effective
intervention, although the evidence is still limited due to the small number of
available studies, overlapping data, and identified methodological
weaknesses.

 

 

COMMITTEE MEMBERS:
Interno - 1545315 - GUILHERME AUGUSTO DE FREITAS FREGONEZI
Interna - 5566309 - VANESSA REGIANE RESQUETI FREGONEZI
Externa à Instituição - JESSICA DANIELLE MEDEIROS DA FONSECA - EBSERH