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O papel da sintomatologia na prescrição de um programa estruturado de exercício físico no domicílio na doença arterial periférica: revisão scoping
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A Doença Arterial Periférica (DAP) é uma doença cardiovascular, mais prevalente nos membros inferiores, que compromete a capacidade funcional e qualidade dos indivíduos. A evidência demonstra existir benefícios físicos e psicossociais através da realização de um programa de exercício estruturado e supervisionado. Dada a dificuldade de acessibilidade e limitação de recursos associadas a esta modalidade, têm surgido os programas estruturados no domicílio, enquanto alternativa eficaz. No entanto, persiste uma falta de clareza quanto aos modelos de intervenção descritos na literatura.
Objetivos: Identificar as modalidades e respetivos princípios de prescrição FITT-VP nos programas de exercício no domicílio, bem como compreender o papel da sintomatologia na planificação dos mesmos. Além disso, visa identificar a segurança e adesão destas intervenções e os outcomes para avaliar a sua eficácia. Esta revisão scoping foi conduzida em conformidade com a estrutura metodológica do Joanna Briggs Institute e foi relatada de acordo com a PRISMA-ScR. As pesquisas decorreram nas bases de dados da MEDLINE (PubMed), CENTRAL of Cochrane Library, Web of Science e Google Scholar (fonte de literatura cinzenta). Foram incluídos estudos com texto integral de acesso livre, RCTs, publicados em português ou inglês. Foram analisados 28 estudos entre 2001 e 2024. Todos os estudos incluíram recomendações para realização de um programa de exercício no domicílio, 100% (n=28) a realizarem treino aeróbio e 20% (n=5) a realizarem treino de força muscular, apresentando informação limitada quanto aos princípios de prescrição FITT-VP. Onze estudos (39%) apresentaram as taxas de adesão, que variaram entre baixa e alta. A dimensão física foi representada em 24 estudos (86%), sendo a capacidade de marcha a medida mais avaliada (64%; n=18), através do 6MWT (61%, n=17). Dez estudos (36%) apresentaram dados quanto à ocorrência de eventos adversos. Os dados desta revisão demonstram que a evidência é pouco clara quanto à realização de um programa de exercício estruturado no domicílio, em indivíduos com DAP, com ampla variabilidade nos parâmetros de prescrição e nos outcomes avaliados. A adesão e segurança parecem ser fatores pouco reportados na literatura.
Peripheral Artery Disease (PAD) is a cardiovascular condition, most prevalent in the lower limbs, that significantly compromises functional capacity and quality of life. Evidence demonstrates physical and psychosocial benefits from structured and supervised exercise programs. However, due to accessibility challenges and limited resources associated with this modality, structured home-based programs have emerged as an effective alternative. Nevertheless, there remains a lack of clarity regarding the intervention models described in the literature. To identify the modalities and respective FITT-VP prescription principles of home-based exercise programs, as well as to understand the role of symptomatology in their planning. Additionally, to assess the safety, adherence, and outcomes used to evaluate their effectiveness. This scoping review was conducted in accordance with the methodological framework of the Joanna Briggs Institute and reported following the PRISMA-ScR checklist. Searches were performed in MEDLINE (PubMed), CENTRAL (Cochrane Library), Web of Science, and Google Scholar (grey literature). Only full-text, open-access randomized controlled trials (RCTs) published in portuguese or english were included. Twenty-eight studies published between 2001 and 2024 were analyzed. All studies included recommendations for home-based exercise programs, with 100% (n=28) prescribing aerobic training and 20% (n=5) incorporating resistance training, while providing limited information regarding FITT-VP principles. Eleven studies (39%) reported adherence rates, ranging from low to high. The physical domain was assessed in 24 studies (86%), with walking capacity evaluated in 64% of studies (n=18), most commonly through the 6-minute walk test (61%, n=17). Ten studies (36%) reported data on adverse events. The findings of this review demonstrate that the evidence regarding structured home-based exercise programs for individuals with PAD remains unclear, with substantial variability in training prescription parameters and evaluated outcomes. Adherence and safety appear to be underreported in the literature.
Peripheral Artery Disease (PAD) is a cardiovascular condition, most prevalent in the lower limbs, that significantly compromises functional capacity and quality of life. Evidence demonstrates physical and psychosocial benefits from structured and supervised exercise programs. However, due to accessibility challenges and limited resources associated with this modality, structured home-based programs have emerged as an effective alternative. Nevertheless, there remains a lack of clarity regarding the intervention models described in the literature. To identify the modalities and respective FITT-VP prescription principles of home-based exercise programs, as well as to understand the role of symptomatology in their planning. Additionally, to assess the safety, adherence, and outcomes used to evaluate their effectiveness. This scoping review was conducted in accordance with the methodological framework of the Joanna Briggs Institute and reported following the PRISMA-ScR checklist. Searches were performed in MEDLINE (PubMed), CENTRAL (Cochrane Library), Web of Science, and Google Scholar (grey literature). Only full-text, open-access randomized controlled trials (RCTs) published in portuguese or english were included. Twenty-eight studies published between 2001 and 2024 were analyzed. All studies included recommendations for home-based exercise programs, with 100% (n=28) prescribing aerobic training and 20% (n=5) incorporating resistance training, while providing limited information regarding FITT-VP principles. Eleven studies (39%) reported adherence rates, ranging from low to high. The physical domain was assessed in 24 studies (86%), with walking capacity evaluated in 64% of studies (n=18), most commonly through the 6-minute walk test (61%, n=17). Ten studies (36%) reported data on adverse events. The findings of this review demonstrate that the evidence regarding structured home-based exercise programs for individuals with PAD remains unclear, with substantial variability in training prescription parameters and evaluated outcomes. Adherence and safety appear to be underreported in the literature.
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Palavras-chave
Doença arterial periférica Programa estruturado de exercício Reabilitação Domicílio