Effects of aquatic training and detraining on women with fibromyalgia: controlled randomized clinical trial.

BACKGROUND: Aquatic physical training (APT) promotes improvement of clinical symptoms and aerobic functional capacity in women with fibromyalgia syndrome (FMS). However, there are controversial studies that refer to the maintenance of adaptations obtained from APT after a detraining period. AIM: To evaluate variables oxygen uptake (VO2) relative to lean body mass (LBM) and clinical symptomatology in women with FMS submitted to APT and after 16 weeks of detraining period, and to evaluate the association between the magnitude of VO2 improvement relative to LBM and clinical symptomatology. DESIGN: Blind randomized controlled trial. SETTING: Department of Physical Therapy of the Federal University of São Carlos. POPULATION: Fifty-four women with FMS were randomly assigned into trained group (27) and control group (27). METHODS: All women underwent cardiopulmonary exercise test (CPET) and body composition assessment to estimate VO2 and LBM respectively, and clinical symptoms were assessed before and after 16 weeks of training and detraining. trained group was submitted to APT program, performed twice a week for 16 weeks. RESULTS: After APT, trained group presented an increase in VO2 relative to LBM (P=0.01), in addition to an increase in pressure pain threshold (PPT) (P=0.02) and Visual Analogue Scale (VAS) pain (P=0.01), VAS well-being (P<0.01) well-being and lower Fibromyalgia Impact Questionnaire Score (FIQ) (P=0.04). However, these improvements were not maintained after the 16-week detraining period (P>0.05). In addition, no significant correlations were observed between improvement of clinical manifestations and increased VO2 relative to LBM after APT (P>0.05). CONCLUSIONS: APT contributed both to increase VO2 at VAT and peak CPET, and improved clinical symptoms, but no association was observed. However, after 16 weeks of detraining, these variables were reduced near baseline. CLINICAL REHABILITATION IMPACT: The results of the present study suggest that APT should be continuously performed in order to improve clinical symptomatology and increase the aerobic functional capacity in women with FMS.

Associations Between Heart Rate Recovery Dynamics With Estradiol Levels in 20 to 60 Year-Old Sedentary Women.

It is hypothesized that estradiol levels, as well as aging, influence cardiac autonomic function in women. The main aim of this study was to test the correlations between heart rate recovery (HRR) dynamics, as a proxy of cardiac autonomic function, with estradiol levels and age in women. This cross-sectional study involved 44 healthy women. Heart rate (HR) data were obtained beat-by-beat during the entire experiment. Maximal incremental exercise testing (IET) on a cycle ergometer was performed followed by 6 min of recovery. During the IET recovery period, the overall HRR dynamics were evaluated by exponential data modeling (time constant "τ") where shorter τ indicates faster HRR adjustment. Considering the cardiac autonomic complexity, HRR dynamics were also evaluated by delta (Δ) analysis considering different HR data intervals. The relationship between HRR dynamics, estradiol levels and age was tested by Pearson product-moment correlation. The overall HRR dynamics (i.e., τ) were statistically correlated with age (r = 0.58, p < 0.001) and estradiol levels (r = -0.37, p = 0.01). The Δ analysis showed that the slower overall HRR associated with aging was a consequence of slower dynamics occurring within the 45-210 s interval, indicating slower sympathetic withdrawal. In conclusion, aging effects on HRR in women seems to be correlated with a slower sympathetic withdrawal. In addition, the cardioprotective effect previously associated with estradiol seems not to influence the autonomic modulation during exercise recovery periods in women.

Oxygen uptake and body composition after aquatic physical training in women with fibromyalgia: a randomized controlled trial.

BACKGROUND: Aquatic physical training (APT) has been strongly recommended to improve symptoms in fibromyalgia syndrome (FMS). However, its effects on body composition and whether lean body mass (LBM) directly influences the aerobic functional capacity of this population are still not clear. AIM: To investigate whether APT can help improve body composition and increase the aerobic functional capacity in women with FMS, and whether oxygen uptake (VO2) related to LBM can better quantify the functional capacity of this population. DESIGN: Randomized controlled trial. SETTING: The Federal University of São Carlos, São Paulo, Brazil. POPULATION: Fifty-four women with FMS were randomly assigned to trained group (TG, N.=27) or control group (CG, N.=27). METHODS: All women underwent cardiopulmonary exercise test (CPET) to assess oxygen consumption at ventilatory anaerobic threshold (VAT) and at peak exercise, and also to assess body composition. The TG was submitted to APT program, held twice a week for 16 weeks. The exercise intensity was adapted throughout the sessions in order to keep heart rate and ratings of perceived exertion achieved at VAT. RESULTS: After APT, body composition was not significantly different between groups (TG and CG). In VAT only TG showed increased VO2 related to LBM, since in peak CPET, VO2 in absolute units, VO2 related to total body mass (TBM), VO2 related to LBM and power showed significant differences. Significant difference between VO2 related to TBM and VO2 related to baseline LBM and after 16 weeks of follow-up, both in VAT as in peak CPET in both groups. Significant difference between VO2 related to TBM and VO2 related to LBM at VAT and at peak CPET in both groups at baseline and after 16 weeks of follow-up was observed. CONCLUSIONS: APT with standardized intensities did not cause significant changes in body composition, but was effective in promoting increased VO2 at peak CPET in women with FMS. However, VO2 related to LBM more accurately reflected changes in aerobic functional capacity at VAT level after to APT. CLINICAL REHABILITATION IMPACT: APT with standardized intensities at VAT level is of great interest, since VAT reflects better aerobic functional capacity of patients with FMS than maximum VO2.

Interval training based on ventilatory anaerobic threshold improves aerobic functional capacity and metabolic profile: a randomized controlled trial in coronary artery disease patients.

BACKGROUND: Exercise training has been an essential component of cardiac rehabilitation. However, it is not known if interval training (IT) based on the ventilatory anaerobic threshold (VAT) could be effective in improving aerobic functional capacity and metabolic profile in patients without or with coronary artery disease (CAD). AIM: To investigate the effects of an IT program, based-intensity between 70-110% of workload reached at the VAT, on the aerobic functional capacity and metabolic profile of patients with and without CAD. DESIGN: Randomized controlled trial. SETTING: Outpatients from a cardiac rehabilitation. POPULATION: A sample was composed of 32 patients with CAD (CAD group) and 32 patients without CAD (noCAD group) that were randomized into a trained or control groups. METHODS: Submaximal cardiopulmonary exercise test on the cycle ergometer and blood samples were realized at baseline and post 16 weeks of IT program. The cardiorespiratory variables were obtained at the VAT level. Trained groups (CAD-T, N.=15; noCAD-T, N.=15) underwent a supervised three-week session IT program (30-40 minutes each exercise session, at the intensity workloads equivalent to %VAT [70-110%]) for 16 weeks. RESULTS: After 16 weeks of IT program, there were a significant increase of VO(2VAT) and workload in the trained groups (P<0.05), while in the control groups VO(2VAT) and heart rate decreased (P<0.05). Body mass and body index mass decreased in trained groups (P<0.05), and low-density lipoprotein increased only in noCAD group after 16 weeks (P<0.05). The magnitude of the improvement in VO(2VAT) was related to VO(2VAT) (r=-0.57, P<0.05) and workload (r=-0.52, P<0.05) at baseline. CONCLUSION: The IT program prescribed with intensities based on VAT improved the aerobic functional capacity and decreased body mass and body index mass loss in patients with and without CAD. CLINICAL REHABILITATION IMPACT: IT program based on VAT provides new possibilities for cardiac rehabilitation in relation to individualized exercise prescription of the interval training.

Aerobic exercise improves cardiac autonomic modulation in women with polycystic ovary syndrome.

BACKGROUND: This study aimed to evaluate the effects of aerobic exercise on cardiac autonomic modulation in women with polycystic ovary syndrome (PCOS). METHODS: Thirty women with PCOS (25.8±4.8 years old; body mass index, BMI≥25 kg/m2) were divided into two groups; exercise group (n=15) and control group (n=15). R-R interval was recorded during 15-min at rest in the supine position. Heart rate variability (HRV) was analyzed by linear (rMSSD, SDNN, LF, HF, LFnu, HFnu, and LF/HF) and nonlinear methods (Shannon entropy, SE; symbolic analyses, 0 V%, 1 V%, 2LV%, and 2UV%) at baseline and after 16 weeks. The multivariate analysis of covariance was used to analyze the effects of exercise on HRV indexes, adjusted for changes in BMI, fasting insulin, and testosterone level. RESULTS: The exercise group increased parasympathetic modulation (rMSSD, HF, HFnu, 2UV%; (p<0.05)) and decreased sympathetic modulation (LF, LFnu, 0 V%; (p<0.05)) independently of changes in BMI, fasting insulin, and testosterone level. Moreover, the exercise group decreased resting HR and systolic blood pressure (p<0.05). All parameters remained unchanged in the control group. CONCLUSIONS: Aerobic exercise increased vagal modulation and decreased sympathetic modulation in women with PCOS. This finding reinforces the recommendations for exercise during the clinical management of these patients.

Interval training based on ventilatory anaerobic threshold increases cardiac vagal modulation and decreases high-sensitivity c-reative protein: randomized clinical trial in coronary artery disease.

BACKGROUND: Autonomic dysfunction and inflammatory activity are involved in the development and progression of coronary artery disease (CAD), and exercise training has been shown to confer a cardiovascular benefit. OBJECTIVE: To evaluate the effects that interval training (IT) based on ventilatory anaerobic threshold (VAT) has on heart rate variability (HRV) and high-sensitivity C-reactive protein (hs-CRP) levels, as well as the relationship between both levels, in patients with CAD and/or cardiovascular risk factors (RF). METHOD: Forty-two men (aged 57.88±6.20 years) were divided into two training groups, CAD-T (n= 12) and RF-T (n= 10), and two control groups, CAD-C (n= 10) and RF-C (n=10). Heart rate and RR intervals in the supine position, cardiopulmonary exercise tests, and hs-CRP levels were measured before and after IT. HRV was analyzed by spectral and symbolic analysis. The CAD-T and RF-T underwent a 16-week IT program of three weekly sessions at training intensities based on the VAT. RESULTS: In the RF-T, cardiac sympathetic modulation index and hs-CRP decreased (p<0.02), while cardiac parasympathetic modulation index increased (p<0.02). In the CAD-T, cardiac parasympathetic modulation index increased, while hs-CRP, systolic, and diastolic blood pressures decreased (p<0.02). Both control groups showed increase in hs-CRP parameters (p<0.02). There was a strong and significant association between parasympathetic and sympathetic modulations with hs-CRP. CONCLUSION: The IT program based on the VAT promoted a decrease in hs-CRP associated with improvement in cardiac autonomic modulation.

Interval training based on ventilatory anaerobic threshold increases cardiac vagal modulation and decreases high-sensitivity c-reative protein: randomized clinical trial in coronary artery disease

Background: Autonomic dysfunction and inflammatory activity are involved in the development and progression of coronary artery disease (CAD), and exercise training has been shown to confer a cardiovascular benefit. Objective: To evaluate the effects that interval training (IT) based on ventilatory anaerobic threshold (VAT) has on heart rate variability (HRV) and high-sensitivity C-reactive protein (hs-CRP) levels, as well as the relationship between both levels, in patients with CAD and/or cardiovascular risk factors (RF). Method: Forty-two men (aged 57.88±6.20 years) were divided into two training groups, CAD-T (n= 12) and RF-T (n= 10), and two control groups, CAD-C (n= 10) and RF-C (n=10). Heart rate and RR intervals in the supine position, cardiopulmonary exercise tests, and hs-CRP levels were measured before and after IT. HRV was analyzed by spectral and symbolic analysis. The CAD-T and RF-T underwent a 16-week IT program of three weekly sessions at training intensities based on the VAT. Results: In the RF-T, cardiac sympathetic modulation index and hs-CRP decreased (p<0.02), while cardiac parasympathetic modulation index increased (p<0.02). In the CAD-T, cardiac parasympathetic modulation index increased, while hs-CRP, systolic, and diastolic blood pressures decreased (p<0.02). Both control groups showed increase in hs-CRP parameters (p<0.02). There was a strong and significant association between parasympathetic and sympathetic modulations with hs-CRP. Conclusion: The IT program based on the VAT promoted a decrease in hs-CRP associated with improvement in cardiac autonomic modulation.

Association of estrogen receptor alpha gene polymorphisms with autonomic modulation of heart rate in users and nonusers of oral contraceptives.

BACKGROUND: This study examined the association between estrogen receptor α gene (ESR1) polymorphisms and blood pressure (BP), heart rate (HR) and autonomic modulation of HR in a sample population. STUDY DESIGN: Two hundred thirty-two young healthy women were selected, and those using oral contraceptives (OC) were compared with nonusers (control group). Short-term HR variability (HRV) was evaluated in both the supine and sitting positions using temporal indices rMSSD [square root of the mean squared differences of successive R-R intervals (RRi) divided by the number of RRi minus one], SDNN (root mean square of differences from mean RRi, divided by the number of RRi) and frequency domain methods. Power spectral components were reported at low frequency (LF) and high frequency (HF) and as LF/HF ratio. ESR1 c.454-397T>C (rs2234693) and c.454-351A>G (rs9340799) polymorphisms were determined by polymerase chain reaction and fragment restriction analysis. RESULTS: The ESR1 T>C and A>G polymorphisms had no effect on HR, rMSSD, SDNN, LF, HF or LF/HF ratio (supine or sitting), independently of OC use. The ESR1 T-A, T-G, C-A and C-G haplotypes were not associated with HR, BP or HRV. CONCLUSIONS: ESR1 variants had no effect on the autonomic modulation of HR in young women users and nonusers of OC and may not be implicated in cardiovascular risk in young women.

Assessment of Subjective Perceived Exertion at the Anaerobic Threshold with the Borg CR-10 Scale.

The purpose of this study was to evaluate the anaerobic threshold (AT) with a graphic visual method for estimating the intensity of ventilatory and metabolic exertion and to determine the ratings of perceived exertion (RPE) on the Borg CR-10 scale during a continuous ramp type exercise test (CT-R). Forty healthy, physically active and sedentary young women (age 23.1 ± 3.52 years) were divided into two groups according to their fitness level: active group (AG) and sedentary group (SG) and were submitted to a CT-R on a cycloergometer with 20 to 25 W/min increments. Shortly before the end of each one-minute period, the subjects were asked to rate dyspnea (RPE-D) and leg fatigue (RPE-L) on the Borg CR-10 scale. After the AT was determined with the graphic visual method, the score that the volunteers gave on the Borg CR10 scale was verified. Data were analyzed using the Mann-Whitney and Spearman correlation tests with the significance level set at 5%. The mean ratings of RPE-L and RPE-D at the AT level were not significantly different between groups (p > 0.05). Significant correlations were found between VO2, heart rate (HR), power output and RPE for both groups. The muscular and respiratory RPE, according to the Borg CR-10 scale, were correlated with the AT, suggesting that scores close to 5, which correspond to a "strong" perception, may be used as parameters for quantifying aerobic exercise intensity for active and sedentary individuals. The similar perception of exercise intensity, which corresponded to the AT of different individuals, makes it possible to prescribe exercise at an intensity equivalent to the AT by means of the RPE. Key pointsInterest in quantitative and systematic determination of the AT is growing, however, qualitative studies measure the AT by perceived exertion, are still unsubstantial.Borg CR-10 scale is a category scale with ratio properties consisting of numbers related to verbal expressions, which allows rate comparison between intensities as well as a determination of intensity levels.Scores close to 5 expressed on the Borg CR-10 scale, which correspond to a "strong" perception, may be used as parameters for quantifying the aerobic exercise intensity of both active and sedentary women.