Σκοπός: Η FEV1 αποτελεί μέτρο του βαθμού της απόφραξης των αεραγωγών και γι’ αυτό το λόγο χρησιμοποιείται για τη σταδιοποίηση της ΧΑΠ και του άσθματος. Οι μηχανισμοί που εμπλέκονται και προσδιορίζουν τη δυνατότητα ανοχής στην κόπωση αυτών των ασθενών είναι πλέον πολύπλοκοι και δεν καθορίζονται μόνο από το βαθμό απόφραξης των αεραγωγών . Σκοπός της μελέτης ήταν η αξιολόγηση 1. Του βαθμού που ο λειτουργικός έλεγχος που προηγείται της κόπωσης σχετίζεται με την ανοχή στην κόπωση 2. Της σχέσης που υπάρχει μεταξύ της ποιότητας ζωής και της ανοχής στην κόπωση σε ασθενείς με αποφρακτική πνευμονοπάθεια Υλικό-Μέθοδος: Μελετήθηκαν 163 ενήλικες (107 άνδρες, 56 γυναίκες), οι οποίοι παρακολουθούνται στο τακτικό Πνευμονολογικό Ιατρείο της Πανεπιστημιακής Παθολογικής Κλινικής του Πανεπιστημίου Πατρών. Στην μελέτη περιλήφθησαν 57 ασθενείς (44 άνδρες, 13 γυναίκες) με ΧΑΠ Επίσης περιλήφθησαν 29 ασθενείς με άσθμα (16 άνδρες, 13 γυναίκες). 77 (47 άνδρες, 30 γυναίκες) είχαν φυσιολογική σπιρομέτρηση και χρησιμοποιήθηκαν ως ομάδα ελέγχου. Όλοι οι ασθενείς πριν την έναρξη του λειτουργικού ελέγχου συμπλήρωσαν την ελληνική μετάφραση του ερωτηματολογίου για τις αναπνευστικές νόσους το St. George’s Respiratory Questionnaire και υπεβλήθησαν σε πλήρη λειτυργικό έλεγχο της αναπνοής. Αποτελέσματα: Οι ασθενείς με ΧΑΠ και βαρύτητα νόσου σταδίου Ι είχαν φυσιολογική ανταπόκριση στην άσκηση με φυσιολογική ικανότητα για άσκηση, οι ασθενείς σταδίου ΙΙ είχαν μειωμένη ικανότητα κόπωσης 70%, ενώ οι ασθενείς σταδίου ΙΙΙ και ΙV είχαν πολλή μεγαλύτερη μείωση της ικανότητας για άσκηση. Όσο αφορα τους ασθματικούς 28 από τους 29 ασθματικούς ασθενείς είχαν φυσιολογική VO2peak (109%) και είχαν επαρκείς αναπνευστικές εφεδρείες (>43%), δείγμα ότι το αναπνευστικό σύστημα γι’ αυτούς τους ασθενείς δεν αποτέλεσε περιοριστικό παράγοντα άσκησης. Η ποιότητα ζωής των ασθενών με ΧΑΠ και ιδιαίτερα οι δραστηριότητες τους εξαρτώνται από τη μέγιστη ικανότητα για άσκηση και επομένως από τον περιορισμό των εκπνευστικών ροών όπως αυτές περιγράφονται από την FEF25-75, από τη βλάβη που υφίστανται οι μηχανικές ιδιότητες του πνεύμονα όπως αυτές περιγράφονται από τον MVV καθώς επίσης και από το δείκτη επιφανείας σώματος. Συμπεράσματα: Με αρκετά σημαντική ακρίβεια είναι δυνατόν να προβλεφθεί η μείωση της ικανότητας για άσκηση των ασθενών με ΧΑΠ από τις τιμές του λειτουργικού ελέγχου που προηγείται της άσκησης, ενώ και η ποιότητα ζωής των ασθενών με ΧΑΠ φαίνεται να επηρεάζεται από λειτουργικές παραμέτρους που συμβάλουν στη μειωμένη αυτή ικανότητα για άσκηση που εμφανίζουν οι ασθενείς με αποφρακτική πνευμονοπάθεια. / Exercise tolerance in patients with airflow limitation (COPD and Asthma) has multiple determinants and is difficult to predict from measurements of resting pulmonary function. Measurements of maximum exercise tolerance have been reported to be useful in disability evaluation and determination of the cause of exertional symptoms. In addition, understanding the factors which predict exercise capacity will provide clues to a better understanding of physical activity limitations in patients with airflow limitation (COPD and asthma). Previous studies in patients with COPD have indicated that ventilatory limitation is a primary determinant of exercise tolerance. However, individual pulmonary function parameters as FEV1 explain only about half of the variance in measured exercise tolerance. For many patients with airflow limitation, psychosocial characteristics may interact with physiologic abnormalities to limit physical work capacity. To date, few published studies have closely examined the role of psychosocial variables in the prediction of peak VO2 in patients with COPD and asthma. The Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) statement and GINA statement recommended that chronic obstructive disease and asthma be staged on the basis of the percentage of predicted FEV1. Patients with COPD have restricted respiratory airflow, which predisposes them to dyspnea. To avoid dyspnea, patients develop a sedentary lifestyle that leads to a decreased exercise tolerance, which, in turn, aggravates the dyspnea. The decrease in exercise tolerance is marked by a reduced maximum oxygen consumption (VO2max) and lower ventilatory anaerobic threshold (Vth). This study uses data from a clinical trial of rehabilitation in COPD patient and from outpatient stable asthmatic patient. The purposes of the analysis were the following: to examine how well exercise tolerance, specifically PaO2 after exercise and VO2 peak, can be predicted from a combination of physiologic and psychosocial measurements, and to provide insight into factors determining and limiting exercise capacity in COPD and asthmatic patients. The other purpose of this study was to examine the relation between patients with airway limitation (COPD and Asthma) and health-related quality of life. A total of 57 outpatient stable COPD patients and 29 asthmatic stable patients underwent cardiopulmonary testing and filled in a form of Saint George’s Respiratory Questionnaire (SGRQ). We examined the correlation between GOLD criteria for staging COPD patients and health-related QoL throughout the performance of a cardiopulmonary exercise test. CONCLUSIONS According to our results, maximum exercise tolerance is predicted reasonably well from measurements of resting pulmonary function in COPD patients. The most consistent predictors of VO2 peak were measurements of expiratory airflow limitation (FEF2575) and inspiratory– expiratory strength (MVV); none of the psychosocial variables added significantly to the accuracy of the prediction of peak VO2. In addition, only symptoms (dyspnea) influenced maximum exercise performance and decreased it. The effect of symptoms on VO2max depended on the severity of the disease set by the GOLD guidelines. Our findings indicate that we will have to include additional parameters in GOLD stages, such as the SGRQ and probably ergometry test, when COPD patients are classified. The predicted value and FEV1/FVC <70%) minimally affects health-related QoL, whereas stage II (FEV1, 30% to 80% of the predicted value) and stage III (FEV1< 30% of the predicted value) disease is associated with profound deterioration in health-related QoL. The relation between FEV1 and health-related QoL reported that the QoL was not significantly associated with the percentage of predicted FEV1; Activities are impaired proportionally to GOLD stages in our study. This indicates that COPD patients in early stages do not reduce their activities, but in severe stages (continually diminishing FEV1) their activities are reduced. We found that in COPD patients, activities do not correlate with aximum exercise performance our findings indicate that we will have to include additional parameters in GOLD stages, like SGRQ and probably ergometry test, when COPD patients are classified.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-07-19T17:49:49Z No. of bitstreams: 1 Maria Helena Gomes de Sousa.pdf: 938639 bytes, checksum: 60ae02f298c21e9935dfa190fc6ea44b (MD5) / Made available in DSpace on 2018-07-19T17:49:49Z (GMT). No. of bitstreams: 1 Maria Helena Gomes de Sousa.pdf: 938639 bytes, checksum: 60ae02f298c21e9935dfa190fc6ea44b (MD5) Previous issue date: 2018-02-28 / Ergospirometric test, gold standard evaluation of cardiorespiratory fitness, is not an economically accessible and easy to apply test, especially for patients with Cerebral Vascular Accident (CVA) sequelae. Thus, field tests such as the Shuttle Walk Test Incremental (SWTI) may be another option for evaluation of cardiorespiratory function. Objective: compare the ventilatory, metabolic and cardiovascular responses obtained by the SWT and ergospirometric test, in hemiparetics due to stroke. Secondary objective was compared with the results of the ventilation evaluations with mild, moderate, marked and severe motor impairment of hemiparetic patients. Methodology: transversal study, with 20 hemiparetic subjects, motor impairment (05 mild, 04 moderate, 05 severe, 06 severe), 58 ± 10 years old, 08 women and 12 men. The VO2maximum (VO2), ventilatory (VE), desaturation, heart rate (HR) and blood pressure (BP), during the SWTI and ergospirometry, were evaluated in two days, 48h interval. Results: SpO2 was similar (97 [96-98]; 97 [94-97]) respectively in SWT and ergospirometry. VO2Pico metabolic variables (18 ± 4, 24 ± 4), cardiac FCPic (101 ± 17, 115 ± 15), systolic BP (140 [140-147], 160 [140-160]) and diastolic (2 ± 1, 3 ± 1), fatigue (2 [1-4], 4 [2-6]) and distance traveled (248 ± 154, 409 ± 1) 216). Comparison between groups of motor severity: ergospirometry showed variance in VO2peak and distance traveled between the light and severe group (p <0.05); others did not show significant differences. No SWTI, VO2Pico presented the difference between the moderate and striking groups (p <0.05) and the distance traveled between the light, striking and severe groups (p <0.05). Conclusion: SWTI is not similar to ergospirometry in the hemiparetic population due to stroke. Severe patients have poorer performance in both tests compared to the mild and moderate group, according to a Fugl-Meyer scale. / Teste ergoespirométrico, avaliação padrão ouro da aptidão cardiorrespiratória, não é um teste economicamente acessível e de fácil aplicabilidade, especialmente para pacientes com sequela de Acidente Vascular Cerebral (AVC). Assim, testes de campo como o Shuttle Walk Test Incremental(SWTI) podem ser outra opção de avaliação da função cardiorrespiratória. Objetivo: Comparar as respostas ventilatórias, metabólicas e cardiovasculares, obtidas pelo SWT e teste ergoespirométrico, em hemiparéticos decorrente de AVC. Objetivo secundário foi comparar os resultados das avaliações ventilatórias com o comprometimento motor leve, moderado, marcante e severo, dos pacientes hemiparéticos. Metodologia: estudo transversal, com 20 indivíduos hemiparéticos, comprometimento motor (05 leves, 04 moderados, 05 marcantes, 06 severos), 58±10 anos, 08 mulheres e 12 homens. Foram avaliados o consumo do VO2máximo(VO2), ventilação(VE), dessaturação, frequência cardíaca(FC) e pressão arterial(PA), durante o SWTI e ergoespirometria, realizados em dois dias, intervalo de 48h. Resultados: SpO2 foi semelhante (97[96-98]; 97[94-97]) respectivamente no SWT e ergoespirometria. Foram diferentes: as variáveis metabólicas VO2Pico (18±4; 24±4), cardíacas FCPico(101±17; 115±15), PA Sistólica(140[140-147]; 160[140-160]) e diastólica(85±6; 90±12), esforço percebido dispnéia (2±1; 3±1), fadiga(2[1-4]; 4[2-6]) e distância percorrida(248±154; 409±216). Comparação entre grupos de gravidade motora: ergoespirometria mostrou variância no VO2pico e distância percorrida entre o grupo leve e severo (p<0,05); demais não mostraram diferenças significativas. No SWTI, o VO2Pico apresentou diferença entre os grupos moderado e marcante(p<0,05) e na distância percorrida entre os grupos leve, marcante e severo(p<0,05). Conclusão: O SWTI não é similar à Ergoespirometria na população hemiparética decorrente de AVC. Os paciente severos tem menor desempenho em ambos os testes em comparação com o grupo leve e moderado, de acordo com a escala de Fugl-Meyer.

INTRODUÇÃO: Endomiocardiofibrose (EMF) é uma cardiomiopatia restritiva (CMR), caracterizada por uma disfunção diastólica, mas com a função sistólica e a fração de ejeção preservadas ou, em fases avançadas da doença, pouco prejudicadas. O consumo máximo de oxigênio (VO2) é um marcador de mortalidade na insuficiência cardíaca sistólica (ICS). Apesar da mortalidade ser semelhante entre a CMR e ICS, ainda não é conhecido se o treinamento físico pode melhorar o VO2 pico em pacientes com EMF. O objetivo deste estudo foi verificar se 4 meses de treinamento combinado podem melhorar a capacidade funcional e qualidade de vida em pacientes com EMF. MÉTODOS: Vinte e um pacientes com EMF (classe funcional II e III, NYHA) foram divididos em 2 grupos: treinamento físico (EMF-TF, n = 9) e sedentários (EMF-Sed, n = 12). Foram avaliados: VO2 pico, pulso de O2, relação deltaFC/deltaVO2 e relação deltaVO2/deltaW, pelo teste cardiopulmonar (TECP); volume diastólico final (VDF), volume sistólico (VS) e volume diastólico do átrio esquerdo (AE), pela ecocardiografia (Simpson); e qualidade de vida, pelo questionário Minnesota Living With Heart Failure Questionnaire (MLWHFQ). Os resultados do TECP dos pacientes com EMF foram comparados com os resultados de indivíduos controle saudáveis sedentários (CSS). Foi considerado significativo P < 0,05. RESULTADOS: Idade não foi diferente entre EMF-Sed, EMF-TF e CSS (58±9 vs. 55±8 vs. 53±6 anos, P = 0,31; respectivamente). O grupo EMF-TF apresentou um aumento do VO2 pico pós-intervenção, comparado com o momento pré e comparado com o grupo EMF-Sed, mas esse valor foi menor, comparado ao CSS (17,4 ± 3,0 para 19,7 ± 4,4 vs. 15,3 ± 3,0 para 15,0±2.0 vs. 24,5 ± 4,6 ml/kg/min, P < 0,001; respectivamente). O pulso de O2 do grupo EMF-TF no momento pós-intervenção foi maior, comparado ao momento pré e ao grupo EMF-Sed, mas foi semelhante, quando comparado ao grupo CSS (9,3 ± 2,6 para 11,1 ± 2,8 vs. 8,6 ± 2,2 para 8,6 ± 1 vs. 11,2 ± 2,9 ml/batimentos; P < 0,05; respectivamente). A relação deltaFC/deltaVO2 diminuiu no momento pós-intervenção no grupo EMF-TF, comparado ao momento pré e ao grupo EMF-Sed, igualando-se ao grupo CSS (75 ± 36 para 57 ± 14 vs. 68 ± 18 para 73 ± 14 vs. 56±17 bpm/L; P < 0,05; respectivamente). O grupo EMF-TF reduziu significativamente a relação deltaVO2/deltaW, após o período de treinemento, comparado ao momento pré e ao grupo EMF-Sed, igualando-se ao grupo CSS (12,3 ± 2.8 para 10,2 ± 1.9 vs. 12,6±1.7 para 12,4 ± 1.7 vs. 10,0 ± 0,9 ml/min/Watts; P = 0,002; respectivamente). O treinamento físico também aumentou o VDF do grupo EMF-TF, quando comparado ao grupo EMF-Sed (102,1 ± 64,6 para 136,2 ± 75,8 vs. 114,4 ± 55,0 para 100,4 ± 49,9 ml; P < 0,001; respectivamente) e o VS (57,5±31,9 para 72,2 ± 27,4 vs. 60,1 ± 25,2 para 52,1 ± 18,1 ml; P = 0,01; respectivamente), e diminuiu o volume diastólico do AE [69,0 (33,3- 92,7) para 34,9 (41,1-60,9) vs. 44,6 (35,8-73,3) para 45,6 (27,0-61,7) ml; P < 0,001; respectivamente). A qualidade de vida dos pacientes EMF-TF, quando comparados com o grupo EMF-Sed também melhorou após o período de treinamento físico (45±17 para 27±15 vs. 47±20 para 45 ± 23 pontos; P < 0,05; respectivamente). CONCLUSÃO: Esses resultados esclarecem que os pacientes com EMF se beneficiaram com o treinamento físico combinado, enfatizando a importância dessa ferramenta não farmacológica no tratamento clínico habitual desses pacientes / BACKGROUND: Endomyocardial fibrosis (EMF) is a restrictive cardiomyopathy (RCM), characterized by a diastolic dysfunction, but with preserved systolic function and preserved ejection fraction, except in severe cases, in which these two present mild reduction. Maximal oxygen consumption (VO2) is a marker of mortality in systolic heart failure (SHF). Although mortality in RCM can be similar to SHF, it is still unknown if physical training can improve peak VO2 in patients with EMF. The aim of the present study was to evaluate if 4 months of combined physical training could improve functional capacity and quality of life in patients with EMF. METHODS: Twenty one EMF patients (functional class II and III, NYHA) were divided into 2 groups: physical training (EMF-PT, n = 9) and sedentary (EMF-Sed, n = 12). Peak VO2, O2 pulse, deltaFC/deltaVO2 relation and deltaVO2/deltaW relation were evaluated by cardiopulmonary exercise test (CPX); end diastolic volume (EDV), stroke volume (SV) and left atrium diastolic volume were evaluated by echocardiography (Simpson); and quality of life was evaluated by Minnesota Living With Heart Failure Questionnaire (MLWHFQ). CPX results from EMF patients were compared to a healthy sedentary (HS) control group. Significance was considered P < 0,05. RESULTS: Age was not different between EMF-PT, EMF-Sed and HS (58 ± 9 vs. 55±8 vs. 53 ± 6 years, P = 0,31; respectively). EMF-PT group presented an increase in peak VO2 after training compared to EMF-Sed group, but was lower compared to HS (17,4 ± 3,0 to 19,7 ± 4,4 vs. 15,3 ± 3,0 to 15,0 ± 2.0 vs. 24,5 ± 4,6 ml/kg/min, P < 0,001; respectively). O2 pulse in EMF-PT group increased after training compared to EMFSed group, and was similar compared to HS (9,3 ± 2,6 to 11,1±2,8 vs. 8,6±2,2 to 8,6 ± 1 vs. 11,2±2,9 ml/betas; P < 0,05; respectively). deltaFC/deltaVO2 relation decreased after training in EMF-PT group compared to EMF-Sed group, and was similar compared to HS (75 ± 36 to 57 ± 14 vs. 68 ± 18 to 73 ± 14 vs. 56 ± 17 bpm/L; P < 0,05; respectively). deltaVO2/deltaW relation decreased after training in EMF-PT group compared to EMF-Sed group, and was similar compared to HS (12,3 ± 2.8 to 10,2 ± 1.9 vs. 12,6 ± 1.7 to 12,4 ± 1.7 vs. 10,0 ± 0,9 ml/min/Watts; P = 0,002; respectively). Physical training also increased EDV in EMF-PT compared to EMFSed (102,1±64,6 to 136,2±75,8 vs. 114,4±55,0 to 100,4±49,9 ml; P < 0,001; respectively) and SV (57,5±31,9 to 72,2±27,4 vs. 60,1±25,2 to 52,1±18,1 ml; P = 0,01; respectively), and decreased left atrium diastolic volume [69,0 (33,3-92,7) to 34,9 (41,1-60,9) vs. 44,6 (35,8- 73,3) to 45,6 (27,0-61,7) ml; P < 0,001; respectively). Quality of life in EMF-PT group improved after training when compared to EMF-Sed group (45±17 to 27±15 vs. 47 ± 20 to 45 ± 23 points; P < 0,05; respectively). CONCLUSION: These results point out that patients with EMF benefit from combined physical training emphasizing the importance of this nonpharmacological tool in the clinical treatment of these patients

INTRODUÇÃO: Endomiocardiofibrose (EMF) é uma cardiomiopatia restritiva (CMR), caracterizada por uma disfunção diastólica, mas com a função sistólica e a fração de ejeção preservadas ou, em fases avançadas da doença, pouco prejudicadas. O consumo máximo de oxigênio (VO2) é um marcador de mortalidade na insuficiência cardíaca sistólica (ICS). Apesar da mortalidade ser semelhante entre a CMR e ICS, ainda não é conhecido se o treinamento físico pode melhorar o VO2 pico em pacientes com EMF. O objetivo deste estudo foi verificar se 4 meses de treinamento combinado podem melhorar a capacidade funcional e qualidade de vida em pacientes com EMF. MÉTODOS: Vinte e um pacientes com EMF (classe funcional II e III, NYHA) foram divididos em 2 grupos: treinamento físico (EMF-TF, n = 9) e sedentários (EMF-Sed, n = 12). Foram avaliados: VO2 pico, pulso de O2, relação deltaFC/deltaVO2 e relação deltaVO2/deltaW, pelo teste cardiopulmonar (TECP); volume diastólico final (VDF), volume sistólico (VS) e volume diastólico do átrio esquerdo (AE), pela ecocardiografia (Simpson); e qualidade de vida, pelo questionário Minnesota Living With Heart Failure Questionnaire (MLWHFQ). Os resultados do TECP dos pacientes com EMF foram comparados com os resultados de indivíduos controle saudáveis sedentários (CSS). Foi considerado significativo P < 0,05. RESULTADOS: Idade não foi diferente entre EMF-Sed, EMF-TF e CSS (58±9 vs. 55±8 vs. 53±6 anos, P = 0,31; respectivamente). O grupo EMF-TF apresentou um aumento do VO2 pico pós-intervenção, comparado com o momento pré e comparado com o grupo EMF-Sed, mas esse valor foi menor, comparado ao CSS (17,4 ± 3,0 para 19,7 ± 4,4 vs. 15,3 ± 3,0 para 15,0±2.0 vs. 24,5 ± 4,6 ml/kg/min, P < 0,001; respectivamente). O pulso de O2 do grupo EMF-TF no momento pós-intervenção foi maior, comparado ao momento pré e ao grupo EMF-Sed, mas foi semelhante, quando comparado ao grupo CSS (9,3 ± 2,6 para 11,1 ± 2,8 vs. 8,6 ± 2,2 para 8,6 ± 1 vs. 11,2 ± 2,9 ml/batimentos; P < 0,05; respectivamente). A relação deltaFC/deltaVO2 diminuiu no momento pós-intervenção no grupo EMF-TF, comparado ao momento pré e ao grupo EMF-Sed, igualando-se ao grupo CSS (75 ± 36 para 57 ± 14 vs. 68 ± 18 para 73 ± 14 vs. 56±17 bpm/L; P < 0,05; respectivamente). O grupo EMF-TF reduziu significativamente a relação deltaVO2/deltaW, após o período de treinemento, comparado ao momento pré e ao grupo EMF-Sed, igualando-se ao grupo CSS (12,3 ± 2.8 para 10,2 ± 1.9 vs. 12,6±1.7 para 12,4 ± 1.7 vs. 10,0 ± 0,9 ml/min/Watts; P = 0,002; respectivamente). O treinamento físico também aumentou o VDF do grupo EMF-TF, quando comparado ao grupo EMF-Sed (102,1 ± 64,6 para 136,2 ± 75,8 vs. 114,4 ± 55,0 para 100,4 ± 49,9 ml; P < 0,001; respectivamente) e o VS (57,5±31,9 para 72,2 ± 27,4 vs. 60,1 ± 25,2 para 52,1 ± 18,1 ml; P = 0,01; respectivamente), e diminuiu o volume diastólico do AE [69,0 (33,3- 92,7) para 34,9 (41,1-60,9) vs. 44,6 (35,8-73,3) para 45,6 (27,0-61,7) ml; P < 0,001; respectivamente). A qualidade de vida dos pacientes EMF-TF, quando comparados com o grupo EMF-Sed também melhorou após o período de treinamento físico (45±17 para 27±15 vs. 47±20 para 45 ± 23 pontos; P < 0,05; respectivamente). CONCLUSÃO: Esses resultados esclarecem que os pacientes com EMF se beneficiaram com o treinamento físico combinado, enfatizando a importância dessa ferramenta não farmacológica no tratamento clínico habitual desses pacientes / BACKGROUND: Endomyocardial fibrosis (EMF) is a restrictive cardiomyopathy (RCM), characterized by a diastolic dysfunction, but with preserved systolic function and preserved ejection fraction, except in severe cases, in which these two present mild reduction. Maximal oxygen consumption (VO2) is a marker of mortality in systolic heart failure (SHF). Although mortality in RCM can be similar to SHF, it is still unknown if physical training can improve peak VO2 in patients with EMF. The aim of the present study was to evaluate if 4 months of combined physical training could improve functional capacity and quality of life in patients with EMF. METHODS: Twenty one EMF patients (functional class II and III, NYHA) were divided into 2 groups: physical training (EMF-PT, n = 9) and sedentary (EMF-Sed, n = 12). Peak VO2, O2 pulse, deltaFC/deltaVO2 relation and deltaVO2/deltaW relation were evaluated by cardiopulmonary exercise test (CPX); end diastolic volume (EDV), stroke volume (SV) and left atrium diastolic volume were evaluated by echocardiography (Simpson); and quality of life was evaluated by Minnesota Living With Heart Failure Questionnaire (MLWHFQ). CPX results from EMF patients were compared to a healthy sedentary (HS) control group. Significance was considered P < 0,05. RESULTS: Age was not different between EMF-PT, EMF-Sed and HS (58 ± 9 vs. 55±8 vs. 53 ± 6 years, P = 0,31; respectively). EMF-PT group presented an increase in peak VO2 after training compared to EMF-Sed group, but was lower compared to HS (17,4 ± 3,0 to 19,7 ± 4,4 vs. 15,3 ± 3,0 to 15,0 ± 2.0 vs. 24,5 ± 4,6 ml/kg/min, P < 0,001; respectively). O2 pulse in EMF-PT group increased after training compared to EMFSed group, and was similar compared to HS (9,3 ± 2,6 to 11,1±2,8 vs. 8,6±2,2 to 8,6 ± 1 vs. 11,2±2,9 ml/betas; P < 0,05; respectively). deltaFC/deltaVO2 relation decreased after training in EMF-PT group compared to EMF-Sed group, and was similar compared to HS (75 ± 36 to 57 ± 14 vs. 68 ± 18 to 73 ± 14 vs. 56 ± 17 bpm/L; P < 0,05; respectively). deltaVO2/deltaW relation decreased after training in EMF-PT group compared to EMF-Sed group, and was similar compared to HS (12,3 ± 2.8 to 10,2 ± 1.9 vs. 12,6 ± 1.7 to 12,4 ± 1.7 vs. 10,0 ± 0,9 ml/min/Watts; P = 0,002; respectively). Physical training also increased EDV in EMF-PT compared to EMFSed (102,1±64,6 to 136,2±75,8 vs. 114,4±55,0 to 100,4±49,9 ml; P < 0,001; respectively) and SV (57,5±31,9 to 72,2±27,4 vs. 60,1±25,2 to 52,1±18,1 ml; P = 0,01; respectively), and decreased left atrium diastolic volume [69,0 (33,3-92,7) to 34,9 (41,1-60,9) vs. 44,6 (35,8- 73,3) to 45,6 (27,0-61,7) ml; P < 0,001; respectively). Quality of life in EMF-PT group improved after training when compared to EMF-Sed group (45±17 to 27±15 vs. 47 ± 20 to 45 ± 23 points; P < 0,05; respectively). CONCLUSION: These results point out that patients with EMF benefit from combined physical training emphasizing the importance of this nonpharmacological tool in the clinical treatment of these patients