Qual o melhor protocolo do teste Sit-To-Stand para avaliar a capacidade funcional de exercício em pacientes com insuficiência cardíaca?

Abstract

Introduction: Recent studies have suggested using the one-minute sit-to-stand test (SST) as an alternative to the 6-minute walk test (6MWT), indicating that it can discriminate and predict the risk of a cardiovascular event in patients with coronary artery disease. The test can be easily performed in a variety of protocols, but there is still a gap for patients with heart failure (HF) within these test varieties. Objective: To verify the association and agreement of the 3 SST protocols and to analyze whether they are capable of predicting functional exercise capacity and quality of life in patients with HF. Methods: This is a cross-sectional research, carried out at the Cardiovascular Physiotherapy Service of the Cardiology Outpatient Clinic of HUWC - UFC, from October 2022 to November 2023. 56 patients diagnosed with HF with normal and reduced ejection fraction were studied and submitted to a clinical evaluation, application of the New York Heart Association (NYHA) functionality scale, TSL of 5 repetitions (TSL-5rep), of 30 seconds (TSL-30s) and of 1 minute (TSL-1min), 6-minute walk test (6MWT), Assessment of Quadriceps Muscle Strength (FMQ) and the Assessment of Quality of Life by the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Considering that the outcomes of the TSL protocols were obtained in different units of measurement, the speed (number of repetitions per second) was used to analyze the 3 tests. Results: Of the 56 individuals, 29 (51.8%) were women, with a mean left ventricular ejection fraction (LVEF) of 50 15.7%, and 30 (53.6%) had reduced LVEF. It was observed that there is  correlation and good agreement between the three TSL protocols (p<0.001). It was also verified that in the 3 protocols the results obtained were below those expected for the population (p<0.05). In addition, a positive correlation (r>0.668) of the 3 tests with the 6MWT and with quality of life (p<0.05) was verified. Quadriceps strength did not show any correlation with the TSL-5rep (r=0.169). The ejection fraction (preserved or reduced) did not impact the result of the tests. Greater changes were observed in the variables of heart rate, peripheral oxygen saturation, systolic blood pressure, dyspnea and lower limb fatigue in the 1-min TSL (p<0.05). The 3 TSL protocols were able to identify subjects with impaired and preserved exercise capacity, but the 1-min TSL presented better discriminative values (AUC=0.629). Age, 6MWT, quality of life and quadriceps strength were able to predict performance in the 3 tests. Conclusion: A good association and agreement was observed between the 3 TSL protocols. In addition, all are able to predict functional exercise capacity in patients with HF; however, the 1- min TSL was the best protocol to evaluate individuals with HF, as it presented moderate associations with clinical outcomes.