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Fisioterapia na reabilitação cardiovascular | SaúdeExperts

Em 1993, a Organização Mundial de Saúde (OMS) definiu a Reabilitação Cardiovascular como sendo a “soma de atividades necessárias para influenciar, favoravelmente tanto a causa subjacente da doença quanto as melhores condições físicas, mentais e sociais, de maneira que os pacientes possam, por meio de seus próprios esforços, prevenir ou readquirir, quando perdido, um papel tão normal quanto possível dentro da comunidade”.

Histórico e evolução da especialidade

Os procedimentos começaram a ser desenvolvidos e descritos de forma organizada a partir do inicio do século XX e preconizavam, no tratamento pós Infarto Agudo do Miocárdio, repouso absoluto no leito por aproximadamente dois meses.

Em 1930 também se preconizava repouso, porém com tempo menor, entre trinta e quarenta dias.

Na década de 1950, o usual era que o paciente permanecesse em repouso por aproximadamente seis semanas, pós evento cardíaco.

Assim, após grande período de inatividade (hoje, decúbito de longa duração), altamente debilitado, o longo tempo de permanência no leito era o grande responsável pela difícil recuperação físico-funcional e clínica.

O paciente apresentava repercussões da doença cardíaca e da inatividade prolongada (que hoje denominamos Síndrome do Imobilismo).

Em 1951, Levine e Lown estudaram a mobilização precoce associada ao ortostatismo, quatorze dias pós evento cardíaco, obtendo como resultado diminuição da morbi-mortalidade.

Nos anos 60, no “Cardiac Garden”, Washington, estabeleceu-se para pacientes pós infarto que foram submetidos a revascularização miocárdica (by pass) um programa de recuperação funcional de dezesseis semanas, com resultados positivos. Ainda nesta década, o Dr. Cooper descrevia o treinamento físico que visava uma condição física “superior” e era utilizado em Astronautas. Foi esta a base para métodos mais estruturados de abordagem fisioterapêutica em cardiopatas.

Como é atualmente

Os atuais programas de reabilitação cardíaca consistem em uma abordagem individualizada dos pacientes, realizada por uma equipe multiprofissional, que compreende, além do exercício físico com ênfase terapêutica, orientações nutricionais, psicossociais e estímulos a mudanças dos hábitos de vida. Tais ações permitem grande avanço na abordagem terapêutica dessas doenças, tanto nas condutas farmacológicas como não farmacológicas.

No entanto, apesar de todo o progresso científico e tecnológico, as doenças cardiovasculares permanecem como uma das principais causas de morbidade e mortalidade no mundo ocidental.

As bases fisiológicas para a obtenção dos benefícios propiciados por um programa de exercícios em pacientes com diagnóstico cardiológico estão relacionadas ao princípio de uma sobrecarga desencadear mecanismos adaptativos em vários sistemas (cardiovascular e muscular, por exemplo), esperando que o esforço físico realizado acima do habitual determine o desencadeamento de tais modificações.

A atividade regular de exercícios físicos influencia a resposta cronotrópica (variação de freqüência cardíaca), diminuindo a frequência cardíaca de repouso e diminuindo as frequências submáximas medidas em tratamento, no qual, para uma mesma carga de esforço, o paciente desenvolve uma freqüência cardíaca mais baixa.

Escassez de fisioterapeutas especialistas

Apesar de todo o desenvolvimento técnico científico da Reabilitação Cardiovascular, nos Estados Unidos apenas uma minoria de indivíduos elegíveis por ano, pós-infarto agudo do miocárdio, são incluídos nestes programas. No Brasil, o panorama não é diferente. O número de serviços de reabilitação cardíaca encontra-se muito aquém da demanda de indivíduos que poderiam ser beneficiados. A ausência de fisioterapeutas especialistas deve ser levada em consideração.

Conclusão

A Doença Arterial Coronariana, neste milênio, tornou-se verdadeira epidemia mundial, observando-se um aumento considerável do número de casos. Assim, é essencial a adoção de medidas preventivas para evitar a progressão e recorrência da doença coronariana e minimizar suas sequelas, objetivando a reintegração e manutenção da vida.

Os programas de reabilitação cardíaca representam uma intervenção terapêutica fundamental, componente essencial dos recursos terapêuticos aplicados em pacientes com doenças cardiovasculares, para que eles retornem à vida produtiva e ativa, apesar das limitações impostas por seu processo patológico.

Referência: Diretriz Sul-Americana de Prevenção e Reabilitação Cardiovascular:
http://publicacoes.cardiol.br/2014/diretrizes/2014/Diretriz_de_Consenso%20Sul-Americano.asp

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Prof. Ms. Emerson Santos

Fisioterapeuta com 25 anos de atuação em UTI/Adulto, especialista em Fisioterapia Cardiopulmonar, pós-graduado em Saúde Pública, Mestre em Educação, professor adjunto das disciplinas de Fisioterapia Pneumológica e Fisioterapia Cardiológica, e de Prática Clínica Supervisionada em Fisioterapia Hospitalar na UNIP/Santos.

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