Association of parent-child health parameters and lifestyle habits - the "epi-family health" longitudinal study protocol.

BACKGROUND: Lifestyle and habits, cardiovascular risk factors (CRF), bone and mental health, dietary habits, physical activity, among others are developed in childhood and adolescence. Family environment has shown to play an important role in these outcomes. However, whether the parent-child relationship lifestyle habits and health parameters can be influenced by physical activity patterns still unclear. The objective of this study will be to monitor and investigate the associations between lifestyle habits between parents and their children longitudinally, as well as verify whether in more active parents, the possible associations with lifestyle habits are different from those of parents considered less active. METHODS: The sample will consist of parents (father, mother, or both) and their children /adolescents. The participants will be recruited through public call by flyers spread across all the regions of the city and also through social media. The health parameters will include cardiovascular (cardiac autonomic modulation, blood pressure and resting heart rate), bone mineral density, anthropometric indices, handgrip strength, mental health (quality of life, anxiety and depression symptoms and stress), self-reported morbidities and musculoskeletal pain. Lifestyle habits will include physical activity levels, sedentary behavior, sleep parameters, eating patterns, smoking and alcohol consumption. Sociodemographic variables of age, sex, ethnicity and socioeconomic status will be considered as covariates. The follow-up visits of data collection will be scheduled after a period of 12 months from the baseline assessment during every twelve months. DISCUSSION: The family environment has great potential to determine lifestyle habits in children and adolescents. Based on the results presented in the present study, we hope that health promotion actions can be better designed in the family environment.

Health and lifestyle parameters in peripheral artery disease at two periods of the COVID-19 pandemic: comparison between men and women

ABSTRACT Objective: This study analyzed the impact of sex on self-reported health and lifestyle parameters in peripheral artery disease patients at two periods of the COVID-19 pandemic. Methods: In this longitudinal study, 99 patients with peripheral artery disease (53 men and 46 women) were evaluated during two periods of the COVID-19 pandemic ( i.e ., at onset: May to August 2020, and on follow-up: May to August 2021). Patients were interviewed via telephone, and information regarding lifestyle and health parameters was obtained. Results: At the onset of the COVID-19 pandemic, health and habit parameters were similar between women and men, with 63.0% and 45.3% indicating frequent fatigue, 73.9% and 84.9% reporting increased sitting time, and 23.9% and 39.6% practicing physical activity, respectively. At follow-up, difficulties in physical mobility (women: from 26.1% to 73.9%, p<0.001; men: from 39.6% to 71.7%, p=0.001) and the frequency of hospitalization for reasons other than COVID-19 increased similarly in women and men (women: from 4.3% to 21.7%, p=0.013; men: from 9.4% to 24.5%, p=0.038). The other parameters were similar between the periods. Conclusion: Self-reported physical mobility difficulties and hospitalization frequency increased in women and men with peripheral artery disease.

Associação entre diabetes mellitus e evolução para intubação ou morte para os indivíduos hospitalizados com Covid-19 / Association between diabetes mellitus and evolution to intubation or death for individuals hospitalized with Covid-19

Introdução: Pacientes infectados com COVID-19 parecem manifestar evolução mais grave quando apresentam comorbidades, como a Diabetes Mellitus (DM). No entanto, dados da população brasileira ainda são pouco disponíveis. Objetivo: Analisar a associação entre DM e evolução para intubação e óbito em indivíduos internados com COVID-19. Metodologia: Estudo transversal, observacional, quantitativo com dados dos prontuários de 74 participantes adultos internados no Hospital Professora Lydia Storópoli, com diagnóstico de COVID-19. O Comitê de Ética em Pesquisa Humana aprovou este estudo e os participantes assinaram o termo de consentimento do estudo. Resultados: Dos 74 pacientes, 18 apresentavam DM, dos quais seis evoluíram para intubação e cinco evoluíram para óbito. Não houve associação significativa (p>0,05) entre DM e intubação e óbito. Conclusão: Na presente amostra a DM não foi associada com a evolução clínica para intubação e óbito.

Introduction: Patients infected with COVID-19 seem to manifest a more severe evolution when they have comorbidities, such as Diabetes Mellitus (DM). However, data on the Brazilian population are still scarcely available. Objective: To analyze the association between DM and evolution to intubation and death in individuals hospitalized with COVID-19. Methodology: Cross-sectional, observational, quantitative study with data from the medical records of 74 adult participants admitted to Professora Lydia Storópoli Hospital, diagnosed with COVID-19. The Human Research Ethics Committee approved this study, and participants signed the study consent form. Results: 74 patients with Covid-19, 18 had DM, of which six evolved to intubation, and five evolved to death. There was no significant association (p>0.05) between DM and intubation and death. Conclusion: In the present study, DM was not associated with clinical evolution to intubation and death.

Physiological responses during walking in men and women with intermittent claudication

ABSTRACT Objective Peak oxygen consumption (VO2peak), anaerobic threshold, walking economy, and cardiovascular responses during walking are used to guide and monitor walking training in patients with peripheral artery disease and intermittent claudication. Women with peripheral artery disease and intermittent claudication present greater impairments than men, and evaluating training markers according to sex for decisions regarding walking prescription in this population is important. This study aimed to compare VO2peak, walking economy, anaerobic threshold, and cardiovascular responses during walking in men and women with peripheral artery disease and intermittent claudication. Methods Forty patients (20 men and 20 women with similar baseline characteristics) underwent a cardiopulmonary treadmill test (3.2km/h and 2% increase in slope every 2 minutes until maximal leg pain). The VO2 and rate-pressure product were assessed. Data from men and women were compared using t-tests. Results There were no significant differences between men and women (VO2peak: 15.0±4.8 versus 13.9±2.9mL∙kg-1∙min-1, p=0.38; walking economy: 9.6±2.7 versus 8.4±1.6mL∙kg-1∙min-1, p=0.09; anaerobic threshold: 10.5±3.2 versus 10.5±2.2mL∙kg-1∙min-1, p=0.98; rate pressure product at 1st stage: 13,465± 2,910 versus 14,445±4,379bpm∙mmHg, p=0.41; and rate pressure product at anaerobic threshold:13,673±3,100 versus 16,390±5,870bpm∙mmHg, p=0.08 and rate pressure product at peak exercise: 21,253±6,141 versus 21,923±7,414bpm∙mmHg, p=0.76, respectively). Conclusion Men and women with peripheral artery disease and similar baseline characteristics presented similar responses to walking, suggesting that decisions regarding walking prescription and monitoring can be made regardless of sex in this specific population.

Efeito da estimulação elétrica transcutânea do nervo vago na inflamação, modulação autonômica cardíaca e evolução clínica dos pacientes com COVID-19: estudo de protocolo para um ensaio clínico, controlado, randomizado e cego / Efecto de la estimulación eléctrica transcutánea del nervio vago sobre la inflamación, la modulación autonómica cardiac y la evolución clínica de pacientes con COVID-19: estudio de protocolo para un ensayo clínico, controlado, aleatorizado y ciego / Effects of transcutaneous auricular vagus nerve stimulation on inflammation, cardiac autonomic modulation, and clinical evolution of patients with COVID-19: protocol for a clinical, controlled, randomized, and blind trial

RESUMO O objetivo deste estudo é avaliar o efeito da estimulação elétrica transcutânea do nervo vago (EETNV) na inflamação, modulação autonômica cardíaca e evolução clínica dos pacientes com COVID-19. Trata-se de um ensaio clínico, controlado por sham, randomizado e cego, no qual participarão 52 indivíduos hospitalizados com diagnóstico de COVID-19, que serão randomizados em dois grupos de tratamento: grupo experimental (tratamento médico usual associado à EETNV ativa) ou grupo-controle (tratamento médico usual associado à EETNV sham). A EETNV será realizada por meio de um estimulador elétrico neuromuscular (modelo Dualpex 071 da Quark Medical Products), com o eletrodo de estimulação posicionado sobre o tragus esquerdo, com corrente alternada, frequência de 30Hz e variação de 50%, intensidade ajustada para o limiar sensorial do paciente, com duração de 90 minutos cada sessão de estimulação, duas vezes ao dia, durante sete dias consecutivos, totalizando 14 sessões. Serão avaliados pré e pós-intervenção o nível de interleucina-6 (IL-6) e interleucina-10 (IL-10), cortisol e proteína C reativa (PCR), pressão arterial, variabilidade da frequência cardíaca pelos parâmetros de baixa frequência (BF), alta frequência (AF) e pela razão da baixa e alta frequência (BF/AF), além de evolução clínica dos pacientes, incluindo o nível de ansiedade e depressão, cujos dados serão obtidos por meio de prontuários e questionários. Será realizado também um acompanhamento 7 e 14 dias após o término das intervenções para verificar a evolução clínica, incluindo nível de ansiedade e depressão, e durante seis meses serão avaliadas memória e atenção.

RESUMEN El objetivo de este estudio es evaluar el efecto de la estimulación eléctrica transcutánea del nervio vago (EETNV) sobre la inflamación, la modulación autonómica cardíaca y la evolución clínica de pacientes con COVID-19. Se trata de un ensayo clínico, controlado por simulado, aleatorizado y ciego, en el que participarán 52 individuos hospitalizados diagnosticados de COVID-19, que serán aleatorizados en dos grupos de tratamiento: grupo experimental (tratamiento médico habitual asociado a la EETNV activa) o grupo control (tratamiento médico habitual asociado a la EETNV simulada). La EETNV se realizará mediante un estimulador eléctrico neuromuscular (modelo Dualpex 071 de Quark Medical Products), con el electrodo de estimulación colocado en el trago izquierdo, con corriente alterna, frecuencia de 30Hz y 50% de variación, intensidad ajustada al umbral sensorial del paciente, con una duración de 90 minutos cada sesión de estimulación, dos veces al día, durante siete días consecutivos, lo que totaliza 14 sesiones. Se evaluarán antes y después de la intervención la interleucina-6 (IL-6) y la interleucina-10 (IL-10), el cortisol y la proteína C reactiva (PCR), la presión arterial, la variabilidad de la frecuencia cardíaca por los parámetros de baja frecuencia (BF), alta frecuencia (AF) y razón de baja y alta frecuencia (BF/AF), así como la evolución clínica de los pacientes, incluidos los parámetros de ansiedad y depresión cuyos datos se obtendrán de historias clínicas y cuestionarios. También se realizará un seguimiento de 7 y 14 días tras finalizadas las intervenciones para verificar la evolución clínica, incluidos el nivel de ansiedad y de depresión, y durante seis meses se evaluará la memoria y la atención.

ABSTRACT This study aims to evaluate the effect of transcutaneous auricular vagus nerve stimulation (taVNS) on inflammation, cardiac autonomic modulation, and clinical evolution of patients with COVID-19. This is a clinical, sham-controlled, randomized, and blind trial, in which 52 hospitalized individuals diagnosed with COVID-19 will participate. They will be randomized into: experimental group (usual medical treatment associated with active taVNS) and control group (usual medical treatment associated with sham taVNS). The taVNS will be performed by a neuromuscular electric stimulator (Dualpex model 071 of Quark Medical Products), with the stimulation electrode positioned on the left tragus, with alternating current, at a 30Hz frequency with 50% variation. Intensity will be adjusted to the patient's sensory threshold, with 90-minutes-long stimulation sessions, happening twice per day for seven consecutive days, totaling 14 sessions. Interleukin-6 (IL-6) and interleukin-10 (IL-10), cortisol and C-reactive protein (CRP), blood pressure, heart rate variability (HRV) by low frequency (LF), high frequency (HF) and low and high frequency ratio (LF/HF) parameters will be evaluated before and after the intervention, as well as patients' clinical evolution-including anxiety and depression levels-whose data will be obtained through medical records and questionnaires. A follow-up will also be performed seven and 14 days after the end of the interventions to verify the clinical evolution, including anxiety and depression levels. Memory and attention levels will be evaluated for six months.

Impacto do câncer em pacientes com doença arterial periférica / Impact of cancer in patients with peripheral artery disease

Introdução e Objetivo: O impacto do câncer em pacientes com DAP sobre nível de atividade física diária, capacidade funcional, função cardiovascular e qualidade de vida ainda não é conhecido, sendo, portanto, o objetivo deste presente estudo. Métodos: Estudo transversal com 299 pacientes. Nível de Atividade física (acelerômetro), capacidade funcional (teste de caminhada de 6 minutos, Handgrip, Short Physical Performance Battery, Walking Impairment Questionnaire-WIQ e o Walking Estimated-Limitation Calculated by History), função cardiovascular (pressão arterial braquial, variabilidade da frequência cardíaca e rigidez arterial) e qualidade de vida (WHOQOL-bref) foram comparados entre os pacientes com DAP com e sem histórico de câncer. Resultados: Pacientes com DAP e câncer (N=27) apresentaram melhor desempenho no domínio da distância e da velocidade do WIQ (21±37 vs 14±26, p=0.036; 29±18 vs 22±15, p=0.022, respectivamente) comparado aos pacientes com DP sem câncer. Os outros parâmetros foram similares entre os grupos. Conclusão: Os pacientes com DAP e câncer apresentaram

Introduction and Objective: The impact of cancer in patients with PAD on the level of daily physical activity, functional capacity, cardiovascular function and quality of life is not yet known, thus being the objective of this present study. Methods: Cross-sectional study with 299 patients. Physical activity level (accelerometer), functional capacity (6-minute walk test, Handgrip, Short Physical Performance Battery, Walking Impairment Questionnaire-WIQ and the Walking Estimated-Limitation Calculated by History), cardiovascular function (brachial blood pressure, variability of heart rate and arterial stiffness) and quality of life (WHOQOL-bref) were compared between patients with PAD with and without a history of cancer. Results: Patients with PAD and cancer (N=27) performed better in the distance and speed domains of the WIQ (21±37 vs 14±26, p=0.036; 29±18 vs 22±15, p=0.022, respectively) compared to PD patients without cancer. The other parameters were similar between groups. Conclusion: Patients with PAD and cancer had better results for subjectively assessed functional capacity.

Alterações Longitudinais nos Níveis de Atividade Física e Parâmetros de Risco Cardiovascular em Pacientes com Doença Arterial Periférica Sintomática / Longitudinal Changes in Physical Activity Levels and Cardiovascular Risk Parameters in Patients with Symptomatic Peripheral Artery Disease

Resumo Fundamento: Estudos transversais anteriores demonstraram que a atividade física está associada a menor risco cardiovascular em pacientes com doença arterial periférica (DAP). No entanto, não é possível estabelecer causalidade e estudos com desenho longitudinal são necessários. Objetivo: Analisar as alterações nos parâmetros de risco cardiovascular e níveis de atividade física após 2 anos de acompanhamento em pacientes com DAP sintomática. Métodos: O presente estudo teve início em 2015. Na primeira fase, foram incluídos 268 pacientes. Na segunda fase, após 2 anos (mediana = 26 meses), foram reavaliados 72 pacientes. Parâmetros de risco cardiovascular, como pressão arterial, modulação autonômica cardíaca e rigidez arterial, e níveis de atividade física foram medidos na linha de base e após 2 anos de acompanhamento. A associação entre as alterações delta (valores após 2 anos - valores da linha de base) na atividade física e nos parâmetros cardiovasculares foi analisada por meio de regressão linear múltipla. O nível de significância foi estabelecido em p < 0,05 com DAP. Resultados: Pacientes reduziram seus níveis totais de atividade física em comparação com a linha de base (linha de base = 2.257,6 ± 774,5 versus acompanhamento = 2.041 ± 676,2 min/semana, p = 0,001). Após o acompanhamento, o índice tornozelo-braquial (0,62 ± 0,20 versus 0,54 ± 0,20, p = 0,003) e o desvio padrão de todos os intervalos RR (43,4 ± 27,0 versus 25,1 ± 13,4 ms, p < 0,001) foram menores, enquanto a velocidade da onda de pulso carotídeo-femoral foi maior (9,0 ± 3,0 versus 10,7 ± 3,4 m/s, p = 0,002) em relação aos valores basais. Não observamos associação entre os valores delta dos níveis de atividade física e os parâmetros de risco cardiovascular. Conclusão: Pacientes com DAP tiveram níveis reduzidos de atividade física e comprometimento em relação aos parâmetros de risco cardiovascular após 2 anos de acompanhamento.

Background: Previous cross-sectional studies have demonstrated that physical activity is associated with lower cardiovascular risk in patients with peripheral artery disease (PAD). However, it is not possible to establish causality, and longitudinal design studies are required. Objective: To analyze the changes in cardiovascular risk parameters and physical activity levels after a 2-year follow-up in patients with symptomatic PAD. Methods: This study started in 2015. In the first phase, 268 patients were included. In the second phase, after 2 years (median = 26 months), 72 patients were re-evaluated. Cardiovascular risk parameters, such as blood pressure, cardiac autonomic modulation, and arterial stiffness, and physical activity levels were measured at baseline and after 2 years of follow-up. Association among delta changes (values from follow-up - baseline) in physical activity and cardiovascular parameters were analyzed by multiple linear regression. The significance level was set at p < 0.05. Results: Patients reduced their total physical activity levels compared to baseline (baseline = 2257.6 ± 774.5 versus follow-up = 2041 ± 676.2 min/week, p = 0.001). After follow-up, ankle-brachial index (0.62 ± 0.20 versus 0.54 ± 0.20, p = 0.003), and standard deviation of all RR intervals (43.4 ± 27.0 versus 25.1 ± 13.4 ms, p < 0.001) were lower, whereas carotid-femoral pulse wave velocity was higher (9.0 ± 3.0 versus 10.7 ± 3.4 m/s, p = 0.002) compared to baseline values. We did not observe any association among delta values of physical activity levels and cardiovascular risk parameters. Conclusion: Patients with PAD had reduced physical activity levels and impaired cardiovascular risk parameters during 2-year follow-up.

Are physical inactivity, sitting time and screen time associated with obstructive sleep apnea in adults? A cross-sectional study

Abstract BACKGROUND: Sitting time, screen time and low physical activity (PA) levels have been associated with several diseases and all-cause mortality. PA is related to better sleep quality and absence of daytime sleepiness, along with lower risks of obstructive syndrome apnea (OSA). However, studies on the relationship between sitting time, screen time and OSA are scarce in the literature. OBJECTIVE: To analyze associations between PA levels, sitting time, screen time and OSA among adults with suspected sleep disorder. DESIGN AND SETTING: Cross-sectional study conducted at Hospital Israelita Albert Einstein. METHODS: Data were collected from 369 adults with suspected sleep disorders who visited the hospital's neurophysiology clinic between August 2015 and January 2017. RESULTS: Correlations between hypopnea and PA indicators were demonstrated for total sitting time (0.123; P = 0.019) and total screen time (0.108; P = 0.038). There was also a correlation between latency for rapid-eye-movement sleep (REM_LAT) and total sitting time (0.103; P = 0.047) and a negative correlation between mean oxyhemoglobin saturation (SaO_Avg) and total PA time (-0.103; P = 0.048). There were no associations between PA parameters and apnea-hypopnea index. After adjusting for confounding factors (body mass index, age and gender), sitting time and screen time were not associated with OSA. CONCLUSION: After adjusting for anthropometric and clinical factors, excessive sitting time or screen time was not associated with OSA in adults suspected of sleep disorders. Age, gender, hypertension, body mass index and waist circumference were associated with OSA.

Recreational Physical Activity Improves Adherence and Dropout in a Non-Intensive Behavioral Intervention for Adolescents With Obesity.

Purpose: The aim of this study was to compare adherence and dropout rates in adolescents with obesity participating in a behavioral-counseling intervention with or without recreational physical activity (PA). Material and methods: Seventy-four adolescents (13 to 18y, 40 girls and 34 boys) with obesity (body mass index [BMI] z-score ≥ 2.0) were randomized into a counseling group (CG; n = 37) and a counseling + recreational physical activity group (CPAG; n = 37). Adolescents from both groups received behavioral counseling once a week for 12 weeks and monthly for an additional 12 weeks. CPAG adolescents participated in supervised recreational physical activity sessions twice a week for 12 weeks. Body composition, body image dissatisfaction, symptoms of depression, binge eating, bulimia, anorexia and quality of life were assessed at baseline and after 24-weeks. Result: The dropout rate was 2.73 times higher in adolescents from CG compared to CPAG (χ2 = 4.48; p = .034; R2McF = 0.044). Girls were 2.56 times more likely to withdraw when compared to boys (χ2 = 3.86; p = .049; R2McF = 0.038). Binomial logistic regression which incorporated sex, intervention group, BMI z-score and BSQ score at baseline (R2McF = 0.177) explained 75% of the dropout rate. Both interventions were effective in reducing waist circumference (p < .01) and improving quality of life, symptoms of depression, bulimia and binge eating (p < .01). Conclusion: Incorporating a recreational physical activity component to a non-intensive behavioral intervention may be a feasible strategy to reduce dropout rates in adolescents with obesity seeking treatment.

Association between frequency of physical education classes and heart rate variability in adolescents boys: a cross-sectional study / Associação entre frequência de aulas de educação física e variabilidade de frequência cardíaca em meninos adolescentes: um estudo transversal

ABSTRACT Physical inactivity is associated with low heart rate variability (HRV) in adolescents. However, whether the number of physical education (PE) classes impact HRV remains unclear. This cross-sectional study verified the association between the frequency of PE classes and HRV parameters in male adolescents. This study included 1152 boys (16.6 ± 1.2 years). The quantity of PE classes was assessed though questionnaire and the adolescents were stratified accordingly (no PE class; one PE class/wk; ≥2 PE classes/wk). Time- (SDNN, RMSSD, PNN50) and frequency-domains (LF, HF, sympathovagal balance) of HRV were obtained. Generalized Linear Models were used for comparing the HRV parameters according to the quantity of PE classes, adjusting for confounders. There was no difference in HRV measures of time: (SDNN, p = 0.77; RMSSD, p=0.72; PNN50, p=0.83) and frequency (LF, p=0.61; HF, p=0.61; sympathovagal balance, p=0.60) between the different frequencies of PE classes. The frequency of PE classes in not associated with HRV parameters of male adolescents.

RESUMO A inatividade física está associada à baixa variabilidade da frequência cardíaca (VFC) em adolescentes. Entretanto, não está claro se o número de aulas de Educação Física (EF) causa impacto na VFC. Este estudo transversal verificou a associação entre a frequência das aulas de EF com parâmetros de VFC em adolescentes do sexo masculino. Foram incluídos 1.152 meninos (16,6 ± 1,2 anos). A quantidade de aulas de EF foi avaliada através de questionário e os adolescentes foram estratificados de acordo (nenhuma aula de EF; uma aula de EF / sem; ≥2 aulas de EF / sem). Os domínios do tempo (SDNN, RMSSD, PNN50) e da frequência (LF, HF, balanço simpático-vagal) da VFC foram obtidos. Modelos Lineares Generalizados foram usados ​​para comparar os parâmetros da VFC de acordo com a quantidade de aulas de EF, ajustando para fatores de confusão. Não houve diferença nas medidas de VFC de tempo: (SDNN, p = 0,77; RMSSD, p = 0,72; PNN50, p = 0,83) e frequência (LF, p = 0,61; HF, p = 0,61; balanço simpatovagal, p = 0,60) entre as diferentes frequências das aulas de EF. A frequência das aulas de EF não está associada aos parâmetros de VFC de adolescentes do sexo masculino.

The effects of COVID-19 stay-at-home orders on physical activity of people with obesity

ABSTRACT Objective To verify the association of changes on physical activity levels during coronavirus disease 2019 (COVID-19) outbreak of individuals with normal weight and overweight/obesity, and the influence of sex in this relationship. Methods This cross-sectional study (survey research) was conducted in Brazil between May 5 and May 17, 2020. Participants (n=1,828 / 1,062 women >18 years) were invited through social media to answer a structured questionnaire via Google Forms. The online assessment included self-reported responses to questions on physical activity, overall health, weight, and height. Binary logistic regression analyzed the relationship between overweight/obesity (body mass index ≥25kg/m2), the impact of COVID-19 on physical activity level, and the influence of sex. Results Compared to normal weight people, those with overweight/obesity practice less moderate to vigorous physical activity (p<0.001). There were associations between women and men with overweight/obesity and the impact of COVID-19 on the physical activity practice compared to normal weight people, adjusted by age, education level, social isolation, and previous physical activity level (p<0.017). Conclusion The study found an association of weight and changes in physical activity levels. Individuals with overweight/obesity were more likely to have a lower physical activity level during COVID-19 pandemic, regardless of sex.

Effects of isometric handgrip training on blood pressure among hypertensive patients seen within public primary healthcare: a randomized controlled trial

ABSTRACT BACKGROUND: Meta-analyses have demonstrated that isometric handgrip training (IHT) decreases blood pressure in hypertensive individuals. Nonetheless, most studies were conducted in laboratory settings and its effects in real-world settings remain unclear. OBJECTIVE: To analyze the effects of IHT on office and ambulatory blood pressure in hypertensive patients attended within primary healthcare. DESIGN AND SETTING: Randomized controlled trial conducted in primary healthcare units within the Family Health Program, Petrolina, Pernambuco, Brazil. METHODS: 63 hypertensive patients (30-79 years old; 70% female) were randomly allocated into IHT or control groups. IHT was performed three times per week (4 x 2 minutes at 30% of maximal voluntary contraction, one-minute rest between bouts, alternating the hands). Before and after the 12-week training period, office and ambulatory blood pressure and heart rate variability were obtained. The significance level was set at P < 0.05 (two-tailed testing) for all analyses. RESULTS: IHT significantly decreased office systolic blood pressure (IHT: 129 ± 4 versus 121 ± 3 mmHg, P < 0.05; control: 126 ± 4 versus 126 ± 3 mmHg, P > 0.05), whereas there was no effect on diastolic blood pressure (IHT: 83 ± 3 versus 79 ± 2 mmHg, P > 0.05; control: 81 ± 3 versus 77 ± 3 mmHg, P > 0.05). Heart rate variability and ambulatory blood pressure were not altered by the interventions (P > 0.05 for all). CONCLUSION: IHT reduced office systolic blood pressure in hypertensive patients attended within primary care. However, there were effects regarding diastolic blood pressure, ambulatory blood pressure or heart rate variability. CLINICALTRIALS.GOV IDENTIFIER: NCT03216317.

Are Vascular Parameters Associated with Walking Impairment in Patients with Claudication?

BACKGROUND: The mechanisms underlying functional impairments in symptomatic PAD patients are controversial and poorly understood. Endothelial dysfunction and arterial stiffness have been proposed as potential mechanisms related to functional impairment in symptomatic PAD patients, however, more studies are needed to confirm these associations. OBJECTIVE: To analyze the association between vascular function and walking impairment in patients with peripheral arterial disease (PAD) and symptoms of claudication. METHODS: This was a cross-sectional study that included 68 patients with symptomatic PAD. All patients underwent an objective (Six-minute walk test [6MWT], 4-meter walk test) and a subjective (Walking Impairment Questionnaire [WIQ]) measurement of walking impairment. Vascular parameters measured were pulse-wave velocity (PWV) and flow-mediated dilation (FMD). Multiple linear regression was performed to investigate the association among walking impairment variables with vascular function parameters. RESULTS: No significant associations between the claudication onset distance (PWV: b=.060, P = 0.842; FMD: b=-.192, P = 0.456), 6MWT (PWV: b=.007, P = 0..975; FMD: b=.090, P = 0.725), WIQ distance (PWV: b=.337, P = 0.117; FMD: b=-.025, P = 0.895) WIQ speed (PWV: b=.320, P = 0.181; FMD: b=-.028, P = 0.497), WIQ stairs (PWV: b=.256, P = 0.204; FMD: b=-.228, P = 0.230), 4-meter usual walk (PWV: b=-.421, P = 0.107; FMD: b=-.338, P = 0.112), 4-meter fast walk (PWV: b=-.496, P = 0.063; FMD: b=-.371, P = 0.086) and vascular function were found. CONCLUSIONS: In symptomatic PAD patients, vascular function is not associated to walking impairment, even when adjusting for comorbid conditions and diabetes.

Sensibilidade e especificidade de pontos de corte para frequência cardíaca em repouso de 6. 794 adolescentes Brasileiros: Um estudo transversal / Sensitivity and specificity of cutoff points of resting heart rate from 6, 794 brazilian adolescents: A cross-sectional study

Resumo Fundamento A frequência cardíaca em repouso (FCR) pode ser uma ferramenta útil de triagem para o risco cardiovascular. Porém, os pontos de corte para FCR nunca foram descritos em populações jovens. Objetivo Estabelecer os pontos de corte para FCR em adolescentes brasileiros e analisar se há associação entre pontos de corte e fatores de risco cardiovascular. Métodos A amostra foi composta por 6.794 adolescentes (de 10 a 19 anos). A pressão arterial e a FCR foram avaliadas por dispositivo oscilométrico. Também foram avaliados o índice de massa corporal e a circunferência da cintura. Foi adotada a curva ROC para analisar a sensibilidade e especificidade, e as associações de FCR elevada com os fatores de risco cardiovascular foram analisadas por regressão logística binária. Foi considerado estatisticamente significante um valor de p < 0,05 para todas as análises. Resultados Os valores médios da FCR eram mais altos entre os participantes de 10 a 14 anos do naqueles de 15 a 19 anos, em meninos (p < 0,001) e meninas (< 0,001). Os pontos de corte de FCR propostos para detecção de fatores de risco cardiovascular foram significativos para meninos de 10 a 14 (> 92 bpm) e de 15 a 19 anos (> 82 bpm) e para meninas de 15 a 19 anos (> 82 bpm) (p < 0,05 para todos), enquanto nenhum ponto de corte foi identificado para as meninas de 10 a 14 anos (p > 0,05). Os pontos de corte propostos para a FCR foram associados com obesidade abdominal, sobrepeso e pressão arterial elevada em meninos e meninas. Os pontos de corte da FCR foram associados ao conjunto de fatores de risco cardiovascular em adolescentes de 15 a 19 anos. Conclusões Os pontes de corte propostos para a FCR foram associados com os fatores de risco cardiovascular em adolescentes.

Abstract Background Resting heart rate (RHR) may be a useful screening tool for cardiovascular risk. However, RHR cutoff points, an interesting clinical approach, have never been described in young populations. Objective To establish RHR cutoff points in Brazilian adolescents and to analyze whether cutoff points are associated with cardiovascular risk factors. Methods The sample was composed of 6,794 adolescents (10 to 19 years old). Blood pressure and RHR were assessed by oscillometric device. Body mass index and waist circumference were also assessed. Receiver operating characteristic curve was adopted to analyze the sensitivity and specificity, and associations of high RHR with cardiovascular risk factors were analyzed by binary logistic regression. A p value < 0.05 was considered statistically significant for all the analyses. Results Mean RHR values were higher among participants ages 10 to 14 years than 15 to 19 years, for boys (p < 0.001) and girls (< 0.001). The proposed RHR cutoff points for cardiovascular risk factors detection were significant for boys ages 10 to 14 (> 92 bpm) and 15 to 19 years (> 82 bpm), as well as for girls ages 15 to 19 years (> 82 bpm) (p < 0.05 for all), whereas no cutoff point was identified for girls ages 10 to 14 years (p > 0.05). Proposed RHR cutoff points were associated with abdominal obesity, overweight, and high blood pressure in boys in girls. RHR cutoff points were associated with the cluster of cardiovascular risk factors in adolescents ages 15 to 19 years. Conclusion The proposed RHR cutoff points were associated with cardiovascular risk factors in adolescents.

Increased Screen Time Is Associated With Alcohol Desire and Sweetened Foods Consumption During the COVID-19 Pandemic.

Background: Elevated screen time has been associated with addictive behaviors, such as alcohol and sugar intake and smoking. Considering the substantial increase in screen time caused by social isolation policies, this study aimed to analyze the association of increased screen time in different devices during the COVID-19 pandemic with consumption and increased desire of alcohol, smoking, and sweetened foods in adults. Methods: A sample of 1,897 adults with a mean age of 37.9 (13.3) years was assessed by an online survey, being composed by 58% of women. Participants were asked whether screen time in television, cell phone, and computer increased during the pandemic, as well as how much time is spent in each device. Closed questions assessed the frequency of alcohol and sweetened food consumption, smoking, and an increased desire to drink and smoke during the pandemic. Educational level, age, sex, feeling of stress, anxiety, depression, and use of a screen device for physical activity were covariates. Binary logistic regression models considered adjustment for covariates and for mutual habits. Results: Increased television time was associated with increased desire to drink (OR = 1.46, 95% CI: 1.12; 1.89) and increased sweetened food consumption (OR = 1.53, 95% CI: 1.18; 1.99), while an increase in computer use was negatively associated with consumption of alcohol (OR = 0.68, 95% CI: 0.53; 0.86) and sweetened foods (OR = 0.78, 95% CI: 0.62; 0.98). Increased cell phone time was associated with increased sweetened food consumption during the pandemic (OR = 1.78, 95% CI: 1.18; 2.67). Participants with increased time in the three devices were less likely to consume sweetened foods for ≥5 days per week (OR = 0.63, 95% CI: 0.39; 0.99) but were twice as likely to have sweetened food consumption increased during pandemic (OR = 2.04, 95% CI: 1.07; 3.88). Conclusion: Increased screen time was differently associated with consumption and desire for alcohol and sweets according to screen devices. Increased time in television and cell phones need to be considered for further investigations of behavioral impairments caused by the pandemic.

Análise da associação entre fumo passivo e consumo de álcool e drogas entre adolescentes / Analysis of the association between passive smoking and alcohol and drug consumption among adolescents

Analisar a associação entre o fumo passivo e o consumo de álcool e drogas ilícitas entre adolescentes. Estudo epidemiológico, descritivo, com abordagem quantitativa e abrangência estadual, em uma amostra de 6.264 adolescentes, captados por amostragem aleatória por conglomerados. Os dados foram recolhidos por meio do Global School-Based Student Health Survey. O teste do Qui-quadrado de Pearson (x²) e a regressão logística binária foram utilizados nas análises dos dados. Observou-se exposição significante ao fumo passivo (70,7%), e identificou-se que a exposição ao fumo passivo esteve associado com o consumo de álcool (OR = 2,04; IC 95%: 1,72 2,42) e drogas ilícitas (OR = 4,33; IC 95%: 2,72 6,90), mesmo entre aqueles adolescentes que não fumam e seus pais não fumam e independentemente do sexo, idade e escolaridade materna. O fumo passivo esteve associado ao consumo de álcool e drogas ilícitas pelos adolescentes, excluindo uso de cigarro por parte dos jovens e dos seus pais

To analyze an association between secondhand smoke and alcohol and illicit drug use among adolescents. Epidemiological, descriptive study, with a quantitative approach and state coverage, in a sample of 6,264 adolescents, captured by random sampling by clusters. Data were collected using the Global School-Based Student Health Survey. Pearson's chi-square test (x²) and binary logistic regression were used in the data analysis. There was a significant exposed to secondhand smoke (70.7%). In addition, it was found that exposure to secondhand smoke was associated with alcohol consumption (OR = 2.04; 95% CI: 1.72 2.42) and illicit drugs (OR = 4.33; 95% CI: 2.72 6.90), even among those adolescents who do not smoke and their parents do not smoke and regardless of gender, age and maternal education. Passive smoking was associated with alcohol and illicit drug use by adolescents, excluding the use of cigarettes by young people and their parents

Atividade física para adultos: Guia de Atividade Física para a População Brasileira / Physical activity for adults: Physical Activity Guidelines for the Brazilian Population

Em 2020, o Ministério da Saúde, em parceria com a Universidade Federal de Pelotas, Rio Grande do Sul, selecionou pesquisadores e pesquisadoras para a elaboração do Guia de Atividade Física para a População Brasileira. O objetivo deste artigo foi apresentar os métodos utilizados, bem como os re-sultados do Guia de Atividade Física para a População Brasileira (Guia) para adultos de 18 a 59 anos de idade. A base para construção do Guia se deu a partir de quatro perguntas norteadoras: O quê, quando, por que e como praticar atividade física (AF)? Para responder essas questões, duas estratégias principais foram adotadas: revisão das evidências científicas e a "escuta" de diferentes grupos estra-tégicos. A partir dos procedimentos realizados, recomenda-se que os adultos acumulem entre 150 e 300 minutos de AF por semana com intensidade moderada e/ou entre 75 e 150 minutos por semana de intensidade vigorosa. Dentre os benefícios identificados, destaca-se a redução de mortalidade por doenças crônicas, melhoria na saúde mental, nos aspectos sociais (e.g. interação com outras pessoas, contato com a cultura local etc.) e emocionais (e.g. autoestima, sensação de bem-estar etc.). Além disso, as recomendações não ficaram restritas aos desfechos supracitados, buscou-se considerar as especificidades e singularidades da população adulta nas diferentes regiões do Brasil, destacando que a AF está envolvida em movimentos populares, sociais e culturais. No Guia também são apresentadas mensagens para superar as principais barreiras da AF, e as redes de apoio existentes para auxiliar a população adulta a ter uma vida fisicamente mais ativa

In 2020, the Brazilian Health Ministry in partnership with the Federal University of Pelotas, Rio Grande do Sul selected researchers for the elaboration of the Brazilian Physical Activity Guide. The objective of this article was to present the methods used as well as the results of the Brazilian Physical Activity Guide for adults from 18 to 59 years of age. The construction of the guide was based on four guiding questions: What, when, why and how to practice physical activity? To answer these questions, two main strategies were adopted: review of scientific evidence and "listening" to different strategic groups. From the procedures performed, it is recommended that adults accumulate between 150 and 300 minutes of physical activity per week of moderate intensity and / or between 75 and 150 minutes per week of vigorous intensity, regardless of the type (aerobics or muscle strengthening). Among the identified benefits, the reduction of mortality due to chronic diseases, improvement in mental health, in social and emotional aspects stands out, (e.g., interaction with other people, contact with local culture etc.) and emotional (e.g., self-esteem, feeling of well-being etc.). In addition, the recommendations were not restricted to the aforementioned outcomes, we sought to consider the specificities and singularities of the adult population in different regions of Brazil. The guide also pre-sents messages to overcome the main barriers of physical activity, and the existing support networks to help Brazilian adults to have a more physically active life

Effects of Exercise Mode on Arterial Stiffness in Symptomatic Peripheral Artery Disease Patients: A Randomized Crossover Clinical Trial.

BACKGROUND: Exercise program has been recommended for the treatment of symptomatic peripheral artery disease (PAD) patients. However, whether exercise promotes reduction in arterial stiffness in these patients, who exhibit high arterial stiffness, is poor known. AIM: To analyze the effects of a single session of resistance, walking, and combined exercises on arterial stiffness in symptomatic PAD patients and to describe individual responses and identify clinical predictors of arterial stiffness responses after exercises. METHODS: Twelve patients with symptomatic PAD underwent four experimental sessions in random order: walking exercise (W - 10 bouts of 2-min walking at the speed corresponding to the onset of claudication pain with 2-min interval among sets), resistance exercise (R - 2 sets of 10 reps in eight resistance exercises), combined exercise (CO - 1 set of 10 reps in eight resistance exercises + 5 bouts of 2-min walking with 2-min interval between) and control session (C - resting in exercise room). Ambulatory arterial stiffness index (AASI) was obtained during ambulatory period after each session. Body mass index, ankle brachial index, sex and age also were evaluated. RESULTS: AASI was lower in R compared to other sessions (R - 0.52 ± 0.05; W - 0.59 ± 0.05; CO - 0.64 ± 0.05; C - 0.60 ± 0.05, P < 0.001), with 75% of patients presenting lower AASI after R session. No difference was found between W, CO and C sessions (P> 0.05). Ankle brachial index was negatively correlated with R and W sessions net effect (r = -0.618 and -0.750, respectively; P< 0.05 for both), no correlation was found with CO. CONCLUSION: A single bout of resistance exercise acutely reduces arterial stiffness in symptomatic PAD, while walking and combined exercise did not alter this variable. This response is more likely to occur in individuals with less severe disease.