recuperación

Curso | Avances en Prevención y Rehabilitación Cardiovascular

 

Desde el Instituto de Medicina del Ejercicio y Rehabilitación de la Fundación Santa Fe lo invitamos a una jornada de actualización en los diferentes aspectos que influyen en un programa exitoso de rehabilitación cardiovascular.

El curso contará con la participación de expertos nacionales e internacionales de diferentes disciplinas como cardiología, enfermería, psicología, nutrición, entre otras.

De manera especial, nos acompañará el Dr. Barry A. A. Franklin, Director de los laboratorios de Rehabilitación Cardíaca y Ejercicio del Hospital William Beaumont y profesor de fisiología en la Wayne State University, Michigan. El Dr. Franklin ha publicado decenas de artículos científicos y libros alrededor de temas como la prevención cardiovascular, el impacto del ejercicio en diferentes condiciones de salud, promoción de la actividad física en diferentes poblaciones, entre otros.

Aquí podrá conocer más del Dr. Franklin.

El curso se realizará el sábado 26 de agosto en el auditorio Rosalba Pacheco de la Fundación Santa Fe de Bogotá (Akr 9 con 119, edificio nuevo). Está dirigido a los diferentes profesionales de la salud vinculados a programas de rehabilitación cardíaca y requiere de inscripción previa.

Aquí encontrará toda la información del curso y el formato de inscripción.

 

Lo esperamos!

 

JD

 

 

blog | Rehabilitación Cardiaca

 

Esta valiosa disciplina de la medicina moderna, ha permitido salvar y mejorar la vida de millones de personas en las últimas décadas. En realidad se trata de un modelo ideal de manejo multidisciplinario del riesgo cardiovascular y metabólico, que ha decantado progresivamente las mejores prácticas clínicas, basadas en la evidencia científica, alrededor del paciente con enfermedad cardiovascular. Las cifras de grandes estudios muestran reducciones de hasta un 30% en la mortalidad, para aquellos pacientes que participan de un buen programa de rehabilitación cardiaca, comparados con aquellos que no tienen acceso o no son remitidos por sus médicos.

Muchos de estos pacientes han vivido un deterioro progresivo o repentino de su salud en múltiples aspectos físicos y mentales. Son frecuentes el sedentarismo, el sobrepeso, la hipertensión, así como el colesterol, los triglicéridos y la glicemia elevados. Siguen siendo sorprendentes las cifras de tabaquismo y consumo excesivo de alcohol, los niveles de ansiedad y depresión, de disfunción sexual y trastornos del sueño. Un buen programa de rehabilitación cardiaca permite a cada paciente, después del infarto o evento cardiovascular, recuperar y muchas veces superar su calidad de vida previa.

A pesar de los grandes progresos en los últimos 10 años, en nuestro país y en Latinoamérica todavía son proporcionalmente muy pocos los pacientes que disfrutan de este tratamiento. Aunque los recursos siguen siendo limitados, nuestro sistema de salud actual lo autoriza y contamos con un buen número de profesionales de la salud entrenados en el tema (médicos especialistas, enfermeras, fisioterapeutas, nutricionistas y sicólogas). Hace tan solo una década se podían contar muy pocos programas en los grandes centros hospitalarios. Los esfuerzos gremiales e institucionales han permitido alcanzar cifras de más de 50 programas en todo el país. Los hospitales y clínicas que manejan eventos cardiovasculares graves han comprendido que no se trata solo de salvar la vida en urgencias y en las unidades de cuidado crítico, sino también de brindar un verdadero manejo integral, que permita una adecuada reintegración de todos los pacientes a sus actividades productivas, familiares y sociales, es decir una verdadera recuperación de su calidad de vida.

En Colombia, como en todo el mundo, debemos reorientar los esfuerzos de la salud hacia la prevención de las grandes causas de enfermedad y muerte. Para los miles de compatriotas que ya padecen la enfermedad cardiovascular o sus consecuencias, aún quedan oportunidades. Los programas de rehabilitación cardiaca ofrecen modelos costo-efectivos que debemos adaptar, fortalecer y escalar para controlar uno de los principales problemas de salud de nuestra época.

 

JD

Este blog fue publicado en la versión impresa del diario El Espectador el domingo 11 de enero, 2015.

Fotografía de Vanessa Collazos MD, todos los derechos reservados.

blog | El dilema de una lesión deportiva

 

La reciente lesión de rodilla de uno de nuestros más destacados futbolistas induce reflexiones interesantes. Todo un país, desde el más humilde colombiano hasta nuestro presidente, se preocupan sinceramente por la salud de Falcao, pero muy especialmente por su incierta recuperación para nuestra soñada participación en Brasil.

Las lesiones deportivas hacen parte de la vida de cualquier atleta, pero sin duda hay factores bien identificados que se asocian a lesiones más graves o más frecuentes. Desconozco los detalles del reciente incidente, pero la traumatología deportiva ha permitido reducir, en cierta magnitud este preocupante fenómeno.

En algunos casos, la minoría de ellos, se trata de mala suerte o una simple casualidad. El exceso de entrenamiento, en duración o intensidad, el aporte nutricional inadecuado, los implementos o técnicas deportivas subóptimas aumentan dramáticamente la probabilidad de un accidente. Con gran frecuencia, los rigores de la competencia a nivel profesional, dados por presiones económicas y políticas, llevan a nuestros virtuosos deportistas a desafiar los principios biológicos del entrenamiento. Se requieren músculos, corazón y hormonas entre otros factores para garantizar el óptimo desempeño.

Circunstancias tan sutiles y difíciles de controlar como la falta de un sueño reparador, la deshidratación, la fatiga por trabajo excesivo, un aporte bajo de proteínas o carbohidratos, sodio, potasio y otros nutrientes pueden predisponer a lesiones deportivas. Como en otras situaciones de la vida, por ejemplo en la aviación, sólo es posible minimizar el número y la gravedad de los accidentes con un abordaje integral, sistemático y objetivo.

Los protocolos rigurosos de prevención han mostrado resultados, tan palpables cómo el número de vidas salvadas por las multas a conductores ebrios. El deportista élite tiene derecho a un grupo técnico y médico que lo proteja y apoye a alcanzar sus metas, aun sacrificando a veces los deseos de fanáticos, directivos y empresarios que sólo ven los resultados a corto plazo y pueden arriesgar la carrera de un atleta profesional.

 

JD

 

Este blog fue publicado en el periódico El Espectador en febrero 1 – 2014

Fotografía de Joshua McKenna usada bajo Licencia de Creative Commons

Selecting & Effectively Using Hydration for Fitness

 

Water is the most essential component of the human body as it provides an important role in the function of cells. Important functions of water include transportation of nutrients, elimination of waste products, regulation and maintenance of body temperature through sweating, maintenance of blood circulation and pressure, lubrication of joints and body tissues, and facilitation of digestion.

More than half of the human body is composed of water, and it is impossible to sustain life without it.

WATER LOSS

Exercise produces an elevation in body temperature, which depends on the intensity and duration of exercise, environmental conditions, clothing worn, and metabolic rate. In order to get rid of the excess heat, your body secretes sweat, which is primarily composed of water and electrolytes such as sodium.

The evaporation of sweat is the primary mechanism of heat loss during exercise. Exercise can lead to substantial water and electrolyte loss from sweat leading to dehydration and, in cases of excessive fluid intake, hyponatremia (low sodium in the blood). However, considerable variability exists from person to person with regard to sweat loss. Therefore, the fluid and electrolyte requirements needed for the athlete are variable from person to person as well. If water and electrolytes are not replaced from these losses, the athlete will have a decrease in performance and perhaps an adverse effect on his or her overall health.

FLUID BALANCE

Thirst is a signal that your body is headed toward dehydration. Therefore, it is important to drink before you feel thirsty and to drink throughout the day. Thirst is not a good indicator of hydration and should not be used to monitor hydration status. One way to check your hydration status is to weigh yourself before and after exercise. The before-exercise measurement is best as a nude weight first thing in the morning after urinating. Comparing your body weight before and after exercise can be used to estimate your sweat loss and your fluid requirements. Any weight loss is likely from fluid loss, so drinking enough to replenish these losses will maintain hydration.

The table below shows us that over a one percent loss in body weight indicates dehydration and over five percent indicates serious dehydration. These fluid losses need to be replaced.

% Body Weight Change

Well Hydrated          -1 to +1%

Minimal Dehydration          -1 to -3%

Significant Dehydration          -3 to -5%

Serious Dehydration          > -5%

Another way to check hydration status is the urine color test. A large amount of light-colored urine means you are well hydrated. The darker the color, the more dehydrated you are.

Selecting hydration-ACSM

DEHYDRATION

Dehydration is the loss of fluids and salts essential to maintain normal body function. Dehydration occurs when the body loses more fluids than it takes in.

Dehydration can lead to:

  • Muscle fatigue
  • Loss of coordination
  • Inability to regulate body temperature
  • Heat illness (e.g., cramps, heat exhaustion, heat stroke)
  • Decreased energy and athletic performance

Moderate caffeine intake does not affect hydration status or urine output. However, alcohol will increase your urine output and decrease hydration. Enhancing palatability of a fluid will help to encourage fluid consumption. This can be done with proper flavoring, proper salt (sodium) content and drinking a cold beverage (15-21 degrees Celsius).

SPORTS BEVERAGES

Carbohydrates within a sports beverage help to replenish your sugar (glycogen) stores and electrolytes help to accelerate rehydration. Sports beverages for use during prolonged exercise should generally contain four to eight percent carbohydrate, 20-30 meq/L of sodium, and 2-5 meq/L of potassium. The need for carbohydrates and electrolytes within sports beverages increases with prolonged activity.

Carbohydrate consumption helps to sustain and improve exercise performance during high-intensity exercise longer than one hour as well as lower-intensity exercise for longer periods. You should ingest one-half to one liter of a sports drink each hour to maintain hydration. Also, sports drinks should not exceed a carbohydrate concentration of eight percent.

HYDRATION BEFORE EXERCISE

Check your hydration status before exercise because there is a wide variability in fluid needs for each person.

  • Drink 16-20 fluid ounces of water or sports beverage at least four hours before exercise.
  • Drink 8-12 fluid ounces of water 10-15 minutes before exercise.

Consuming a beverage with sodium (salt) and/or small meal helps to stimulate thirst and retain fluids.

HYDRATION DURING EXERCISE

  • Drink 3-8 fluid ounces of water every 15-20 minutes when exercising for less than 60 minutes.
  • Drink 3-8 fluid ounces of a sports beverage (5-8 percent carbohydrate with electrolytes) every 15-20 minutes when exercising greater than 60 minutes. 

Do not drink more than one quart/hour during exercise.

HYDRATION GUIDELINES AFTER EXERCISE

Obtain your body weight and check your urine to estimate your fluid losses. The goal is to correct your losses within two hours after exercise.

Drink 20-24 fluid ounces of water or sports beverage for every one pound lost

OVERHYDRATION

Overhydration, also called water intoxication, is a condition where the body contains too much water. This can result in behavioral changes, confusion, drowsiness, nausea/vomiting, weight gain, muscle cramps, weakness/paralysis and risk of death.

In general, overhydration is treated by limiting your fluid intake and increasing the salt (sodium) that you consume. If overhydration is suspected, you should see your doctor for appropriate lab tests and treatment. You should not consume more than one liter per hour of fluid.

 

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Reprinted with permission of the American College of Sports Medicine. Copyright © 2011 American College of Sports Medicine. This brochure is a product of ACSM’s Consumer Information Committee.
Fotografía de Darwin Bell, usada bajo licencia de Creative Commons 

Exercise and the Common Cold

 ACSM Current Comment 

A cold is an inflammation of the upper respiratory tract caused by a viral infection. The common cold is probably the most frequently occurring illness in humans worldwide. More than 200 different viruses cause colds, and rhinoviruses and coronaviruses are the culprits 25-60 percent of the time. Rhinovirus infections often occur during the fall and spring seasons, while the coronavirus is more common during the winter.

The U.S. Centers for Disease Control and prevention estimates that over 425 million colds and flus occur annually in the United States, resulting in $2.5 billion in lost school and work days, and in medical costs. The average person has two or three respiratory infections per year. Young children suffer from six to seven annually.

How does one catch a cold? 

Although still a matter of controversy, growing evidence suggests that at least among adults, cold viruses are passed from person to person primarily by being inhaled into the nose and air passageways (i.e., spread through the air). Viruses can be spread by direct contact with wet nasal discharge, but this may be rare, except perhaps in settings such as day care centers. Severe colds transmit viruses more readily than mild ones because a greater amount of virus is passed into the air by coughing and sneezing. Thus, to hinder the spread of cold viruses, coughs, sneezes and “nose-blows” should be smothered with clean handkerchiefs or facial tissues. It is also a very good idea to wash viruses off the hands with soap and water, and to disinfect one’s surroundings.

Damp, cold or drafty weather does not increase the risk of getting a cold. According to most cold researchers, cold or bad weather simply brings people together indoors, which leads to more person-to-person contact.

Cold Treatment 

Doctors often quip that a cold lasts seven days without treatment, and one week with it. Most nonprescription medications, including antihistamines, decongestants, cough medicines, and analgesics provide only temporary relief of symptoms. These medications can make one feel more comfortable while the body’s immune system gears up to fight off the infection. To get rid of the cold, the immune system must make enough antibodies to destroy the viruses, a process that takes three to four days. Antibiotics that fight bacteria have no value in the treatment of the uncomplicated common cold which is caused by a virus.

Even the old standby – inhaling steam — has little or no beneficial effect on cold symptoms. Vitamin C does not prevent colds, according to most researchers, but may slightly reduce the severity and duration of symptoms. Resting, drinking plenty of hot fluids, and seeking comfort from over-the-counter cold remedies is still all that can be done to treat most colds.

Keeping the immune system in good shape 

Whether one gets sick with a cold after a sufficient amount of the virus has entered the body depends on many factors that affect the immune system. Aging, cigarette smoking, mental stress, poor nutrition, and lack of sleep have all been associated with impaired immune function and increased risk of infection.

Based on current knowledge, good immune function can be maintained by eating a well-balanced diet, keeping life stresses to a minimum, avoiding chronic fatigue, and obtaining adequate sleep. Immune function is suppressed during periods of very low caloric intake and quick weight reduction, so weight loss should be gradual to maintain good immunity.

Can a walk each day keep colds away? 

People who exercise report fewer colds than their inactive peers. For example, one recent survey revealed that 61% of 700 recreational runners reported fewer colds since beginning to run, while only 4 percent felt they experienced more. In another survey of 170 experienced runners who had been training for 12 years, 90% reported that they definitely or mostly agreed with the statement that they “rarely get sick.”

To test this belief scientifically, two well-controlled studies with young and elderly women were conducted. In both studies, women in the exercise groups walked briskly 35-45 minutes, five days a week, for 12-15 weeks, with the control groups remained physically inactive. The results were in the same direction reported by fitness enthusiasts — walkers experienced about half the days with cold symptoms as the sedentary controls.

Other research has shown that during moderate exercise, several positive changes occur in the immune system. Although the immune system returns to pre-exercise levels very quickly after the exercise session is over, each session represents a boost that appears to reduce the risk of infection over the long term.

Can too much exercise hurt? 

Among elite athletes and their coaches, a common perception is that heavy exertion reduces resistance to colds. During the Winter and Summer Olympic Games, clinicians report that “upper respiratory infections abound” and that “the most irksome troubles with athletes are infections.”

To determine whether these anecdotal reports were true, 2,311 marathon runners who ran the 1987 Los Angeles Marathon were studied. During the week following the race, one out of seven runners became sick, which was about five times the rate of runners who trained for, but did not run, the Marathon. During the two-month period before the race, runners training more than 60 miles a week doubled their odds for sickness compared to those training less than 20 miles a week. Researchers in South Africa have also confirmed that after marathon-type exertion, runners are at a high risk for sickness.

The immune systems of marathon runners have been studied under laboratory conditions before and after running 2-3 hours. A steep drop in immune function occurs lasting at least 6-9 hours. Several exercise immunologists believe this allows viruses to spread and gain a foothold.

Rest or exercise when sick? 

Most clinical authorities in the area of immunology recommend:

  • If one has common cold symptoms (e.g., runny nose and sore throat without fever or general body aches and pains), intensive exercise training may be safely resumed a few days after the resolution of symptoms.
  • Mild-to-moderate exercise (e.g., walking) when sick with the common cold does not appear to be harmful. In two studies using nasal sprays of a rhinovirus leading to common cold symptoms, subjects were able to engage in exercise during the course of the illness without any negative effects on severity of symptoms or performance capability.
  • With a symptom complex of fever, extreme tiredness, muscle aches, and swollen lymph glands, 2-4 weeks should probably be allowed before resumption of intensive training.
  • In general, if the symptoms are from the neck up, moderate exercise is probably acceptable and, some researchers would even argue, beneficial, while bed rest and a gradual progression to normal training are recommended when the illness is systemic. If in doubt as to the type of infectious illness, individuals should consult a physician. 

Practical applications 

Although more research is needed, the American College of Sports Medicine (ACSM) supports the viewpoint that moderate physical activity (30 minutes a day, on most, if not all days of the week) exerts less stress on the immune system than does prolonged and intense exercise. Regular and moderate exercise lowers the risk for respiratory infections, a finding consistent with previous reports from ACSM urging people to exercise moderately for enhancement of health and disease prevention. Athletes who must train hard for competition can lower their risk of respiratory infection by following the guidelines listed in this report for keeping the immune system in good shape.

 

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