AimsTo evaluate a telemonitoring strategy based on automated text messaging and telephone support after heart failure (HF) hospitalization. Methods and resultsThe MESSAGE-HF study is a prospective multicentre, randomized, nationwide trial enrolling patients from 30 clinics in all regions of Brazil. HF patients with reduced left ventricular ejection fraction (<40%) and access to mobile phones are eligible after an acute decompensated HF hospitalization. Patients meeting eligibility criteria undergo an initial feasibility text messaging assessment and are randomized to usual care or telemonitoring intervention. All patients receive a HF booklet with basic information and recommendations about self-care. Patients in the intervention group receive four daily short text messages (educational and feedback) during the first 30 days of the protocol to optimize self-care; the feedback text messages from patients could trigger diuretic adjustments or a telephone call from the healthcare team. After 30 days, the frequency of text messages can be adjusted. Patients are followed up after 30, 90, and 180 days, with final status ascertained at 365 days by telephone. Our primary endpoint is the change in N-terminal pro-brain natriuretic peptide (NT-proBNP) levels after 180 days. Secondary endpoints include changes in NT-proBNP after 30 days; health-related quality of life, HF self-care, and knowledge scales after 30 and 180 days; and a composite outcome of HF hospitalization and cardiovascular death, adjudicated by a blinded and independent committee. Conclusions The MESSAGE-HF trial is evaluating an educational and self-care promotion strategy involving a simple, intensive, and tailored telemonitoring system. If proven effective, it could be applied to a broader population worldwide.

Medically supervised exercise programs (MSEPs) are equally recommended for men and women with cardiovascular disease (CVD). Aware of the lower CVD mortality in women, we hypothesized that among patients attending a MSEP, women would also have better survival. Methods: Data from men and women, who were enrolled in a MSEP between 1994 and 2018, were retrospectively analyzed. Sessions included aerobic, resistance, flexibility and balance exercises, and cardiopulmonary exercise test was performed. Date and underlying cause of death were obtained. Kaplan-Meier methods and Cox proportional hazards regression were used for survival analysis. Results: A total of 2236 participants (66% men, age range 33-85 yr) attended a median of 52 (18, 172) exercise sessions, and 23% died during 11 (6, 16) yr of follow-up. In both sexes, CVD was the leading cause of death (39%). Overall, women had a more favorable clinical profile and a longer survival compared to men (HR = 0.71: 95% CI, 0.58-0.85; P < .01). When considering those with coronary artery disease and similar clinical profile, although women had a lower percentage of sex-and age-predicted maximal oxygen uptake at baseline than men (58 vs 78%; P < .01), after adjusting for age, women still had a better long-term survival (HR = 0.68: 95% CI, 0.49-0.93; P = .02). Conclusion:Survival after attendance to a long-term MSEP was better among women, despite lower baseline cardiorespiratory fitness. Future studies should address whether men and women would similarly benefit when participating in an MSEP.

Background and objectiveAdopting healthy lifestyle pillars promotes longer lives free from major chronic diseases. The COVID-19 pandemic imposed behavioural changes and psychological burdens. The aim of this study was to assess changes in medical students' six lifestyle pillars that were imposed by the COVID-19 pandemic. MethodsThis cross-sectional study included 548 Brazilian medical students' digitally collected demographic data and lifestyle characteristics from before and during the pandemic. ResultsThe pandemic had a neutral impact on sleep quality and a predominantly negative impact on interpersonal relationships, exercise and eating. Approximately 67.5% students decreased their tobacco and alcohol use. Spirituality was maintained at 66%. Those who reported having emotional wellbeing (27.9%) during the pandemic fulfilled a higher number of pre-pandemic lifestyle pillars (median [IQR]) when compared with those who reported an absence of wellbeing (4 [3-4] pillars, compared with 3 [2-4], P = 0.006). DiscussionThe results reinforce the importance of adhering to as many lifestyle pillars as possible to preserve emotional wellbeing during periods of stress such as those experienced during the pandemic.THE COVID-19 PANDEMIC has grown exponentially worldwide since December 2019. 1 Brazil implemented social distancing on 13 March 2020, 2 which caused increasing distress and directly affected individuals' mental health, 3 work structures, lifestyles and interpersonal relationships. 2 The lifestyle medicine pillars are based on healthy eating, routine exercise, stress management, avoidance of risky substances, positive relationships and better sleep. 4 People who adopt healthy lifestyle pillars have a longer life expectancy, free from major chronic diseases such as diabetes, cardiovascular diseases and cancer, when compared with people who do not adopt healthy lifestyle pillars. [5][6][7][8] Spirituality helps individuals to develop a sense of purpose in life and has been shown to equip individuals with highly effective strategies for coping with stress. 9 Considering the pandemic's impact on health behaviours, people will likely change how they deal with each pillar.The aim of this study was to assess how the COVID-19 pandemic changed medical students' six lifestyle pillars and to investigate the effect that their previous lifestyles had on their emotional wellbeing during the social distancing period.The lifestyle of Brazilian medical students: What changed and how it protected their emotional wellbeing during the COVID-19 pandemic Research

BackgroundExercise-based cardiac rehabilitation tends to reduce mortality. However, it requires medium/long-term adherence to regular physical exercise. It is relevant to identify the variables that affect adherence to an supervised exercise program (SEP).ObjectiveTo evaluate the influence of pre-participation levels of aerobic and non-aerobic physical fitness components in medium-term adherence to SEP.MethodsA total of 567 SEP participants (65 ± 12 years) (68% men) were studied. Participants adherent to the program for less than 6 months (48%) (non-adherent - NAD) were compared with 52% of participants who were adherent for 6 months or more (adherents - AD). In the non-aerobic fitness, flexibility (FLX) (Flexitest) and muscle power (MPW)/body weight in standing rowing (watts/kg) were evaluated while aerobic fitness was obtained by direct measure of VO2max/body weight (VO2). These measurements were normatized for sex and age based on percentiles (P) (P-FLX/P-MPW) of reference data or percentages of predicted (P-VO2). Additionally, AD and NAD with extreme results (tertiles) were simultaneously compared for the three variables.ResultsThere was no difference between AD and NAD for non-aerobic results, in median [P25-P75], P-FLX: 30 [13-56] and 31 [9-52], respectively, (p = 0.69) and P-MPW: 34 [17-58] and 36 [16-62], respectively (p = 0.96), and for aerobic results (mean ± standard error) P-VO2 (75.9 ± 1.3% and 75.0 ± 1.3%, respectively) (p = 0.83). When comparing extreme tertiles, a difference was found for P-MPW in the lower tertile only, with a slight advantage of AD over NAD- 9 [5-16] versus 4 [1-11] (p = 0.04).ConclusionAlthough awareness of the pre-participation levels of aerobic and non-aerobic physical fitness components is useful for individualized exercise prescription, these variables do not seem to influence medium-term adherence to SEP.