Are Physical Fitness and CRP Related to Framingham Risk Score in HIV+ Adults?

Background. People living with HIV (PLWH) have increased risk of cardiovascular disease (CVD). The Framingham Risk Score (FRS) predicts a 10-year CVD risk. Its relationships to physical fitness and C-reactive protein (CRP) are not well established. The current aim is to determine the links between FRS, physical fitness, and CRP in PLWH. Methods. Participants (n = 87) were assessed on multiple biomarkers. The FRS was calculated with the respective variables. Other variables that correlated significantly with FRS were entered into a regression equation to determine their relationship to FRS. Results. The FRS for men was more than twice that for women (12.8 vs 6.0, P < .001). Men were more fit than women, but most participants were not fit. Aerobic capacity was predictive of FRS in men, but not in women, and muscular strength was not predictive of FRS. Women had more than double the CRP compared with men (7.9 vs 3.5 mg/L, P < .01), and it was unrelated to FRS. Conclusions. In men, aerobic capacity was significantly predictive of FRS, but muscular strength and CRP were unrelated to FRS in both genders. These results do not conclusively demonstrate that physical fitness and CRP are related to FRS in PLWH.

The effectiveness of a community-based exercise program on depression symptoms among people living with HIV.

HIV is a worldwide public health issue affecting millions of individuals, and people living with HIV (PLWH) are often affected by depression. Nonetheless, exercise can prevent and treat depression among PLWH. The aim of the present study was to investigate the effect of exercise on depression symptoms in PLWH. Using a prospective single-arm trial, a semi-supervised community-based exercise intervention was offered 3 times/week for 12 weeks to PLWH (n = 52; age: 49 ± 6 years; HIV diagnosis: 19 ± 15 years). Participants were divided into compliant (≥1 exercise session/week) and non-compliant (<1 exercise session/week) groups according to their attendance in the intervention. Depression symptoms were assessed using the Beck Depression Inventory (BDI), and the change in BDI from baseline to post-intervention was assessed with an analysis of covariance, adjusted for demographics. The post-intervention BDI score was significantly lower (p = 0.027) for the compliant group compared to the non-compliant group, and the rate of improvement from moderate/severe symptoms of depression to minimal symptoms of depression was four times greater in the compliant group. In conclusion, a community-based exercise program may be effective in reducing depression symptoms among PLWH.

Análise das fixações visuais e tomada de decisão de atletas de voleibol das categorias infanto e juvenil / Analysis of visual fixations and decision-making in volleyball athletes from infanto and juvenile categories

Objetiva-se verificar o número e duração das fixações visuais e qualidade da tomada de decisão de atletas de voleibol das categorias Infanto e Juvenil na análise de cenas reais de jogos. Participaram 25 atletas voluntários do sexo masculino, sendo 11 da categoria Infanto (idade média de 16±0,3 anos; experiência na modalidade de 3,2±1,3 anos) e 14 da categoria Juvenil (idade média de 17,6±0,9 anos; experiência na modalidade de 4±0,9 anos). Utilizou-se para o rastreamento ocular e análise do número e duração das fixações visuais o EyeTracking SMI RED500® fixo durante o teste de avaliação de cenas de jogos de voleibol. Para análise da qualidade da tomada de decisão (TD), avaliou-se a primeira resposta que o voluntário verbalizava como a melhor solução para a ação apresentada na cena. Analisaram-se os pressupostos de normalidade (teste de Shapiro-Wilk), homocedasticidade das variâncias (teste de Levene) e esfericidade (teste de Mauchly), os quais não apresentaram valores significativos. Seguiu-se a realização de uma Análise de Variância - ANOVA One-way (fator: categoria; níveis: 2 ­ Infanto e Juvenil), mantendo-se um nível de significância de 5%. Calculou-se ainda o tamanho do efeito (h² parcial) e poder observado (beta). Não foram observadas diferenças entre atletas das categorias infanto e juvenil para as variáveis "número de fixações visuais" (p=0,010), "duração das fixações visuais" (p=0,642) e "qualidade da TD" (p=0,281). Além disso, reportou-se tamanho do efeito pequeno para todas variáveis analisadas. Considera-se que os atletas já sabem onde fixar o olhar, realizando fixações em locais específicos que apresentam qualidade dos sinais relevantes para uma ótima TD, onde pode-se observar que, em se tratando da comparação entre atletas, a qualidade dos sinais relevantes é mais importante do que a quantidade e duração das fixações visuais...(AU)

This study aims to verify the quantity and the duration of visual fixation as well as the quality of decision-making in volleyball athletes from Infanto and Juveline categories on the analysis of real games scenes. Twenty five male athletics volunteered on this study, where 11 were from the Infanto category (16±0,3 years old; 3,2±1,3 years of experience) and fourteen were from the Juvenile category (17,6±0,9 years old; 17,6±0,9 years of experience). An eye tracker (Eye Tracking SMI RED500®) was used for tracking the ocular and to analyze the quantity and duration of visual fixations during an evaluation of volleyball games scenes. The first answer the volunteer verbalized as the best option for the showed scene was used for analyzing the quality of the decision-making (DM).The data normality, the homoscedasticity of variances and the sphericity was performed by Shapiro-Wilk, Levene and Mauchly tests, respectively, with no significate values. The Analysis of Variance ­ ANOVA One-Way (factor: category; levels: 2 ­ Infanto and Juvenile) was performed with the significant level in 5%. The effect size (h²) and the observed power (beta) were also calculated. No differences in the variables quantity of visual fixation (p=0,010), duration of visual fixation (p= 0,642) and quality of DM (p=0,281) were found between the athletes from the Infanto and Juvenile categories. Moreover, the effect size was reported for all variables analyzed. The athletes already know where to fix the stare by gazing in specific locations that present quality of relevant signals for a great DM, where can be noted the quality of relevant signals is more important than the quantity and duration of visual fixation...(AU)

Double-blind, randomized crossover study of intravenous infusion of magnesium sulfate versus 5% dextrose on depressive symptoms in adults with treatment-resistant depression.

AIM: Treatment-resistant depression patients are more likely to suffer from comorbid physical and mental disorders, experience marked and protracted functional impairment, and incur higher health-care costs than non-affected individuals. Magnesium sulfate is a treatment option that may offer great potential for patients with treatment-resistant depression based on prior work in animals and humans. METHODS: Twelve subjects with mild or moderate treatment-resistant depression were randomized into a double-blind crossover trial to receive an infusion of 4 g of magnesium sulfate in 5% dextrose or placebo infusion of 5% dextrose with a 5-day washout in between the 8-day intervention period. Subjects were assessed before and after the intervention for serum and urine magnesium, lipid panel, the Hamilton Rating Scale for Depression, and the Patient Health Questionnaire-9. RESULTS: We found a difference in serum magnesium from day 2 to 8 (pre-infusion) (P < 0.002) and from baseline to day 8 (P < 0.02). No changes were noted on the Hamilton Rating Scale for Depression or the Patient Health Questionnaire-9 24 h post-treatment, but as serum magnesium increased from baseline to day 7, the Patient Health Questionnaire-9 decreased from baseline to day 7 (P = 0.02). CONCLUSION: Magnesium sulfate did not significantly affect depression 24 h post-infusion, but other results were consistent with the literature. The association between changes in serum magnesium and the Patient Health Questionnaire-9 supports the idea that magnesium sulfate may be used to address treatment-resistant depression, an ongoing medical challenge.

The effect of exercise training on disease progression, fitness, quality of life, and mental health in people living with HIV on antiretroviral therapy: a systematic review.

BACKGROUND: Exercise has been associated with improvements in adverse physiological and psychological effects of long-term antiretroviral therapy (ART) in people living with HIV (PLWH). AIM: To summarizes the findings on the effects of aerobic or resistance training alone or combined aerobic and resistance exercise training (CARET) on disease progression, fitness, physical functioning, mental health, and quality of life (QOL) in PLWH receiving ART. A systematic search of articles was performed in several databases, and 20 articles that met inclusion criteria were summarized. RELEVANCE FOR PATIENTS: Aerobic exercise was associated with improvements in aerobic capacity, QOL, and depressive symptoms, while resistance training improved strength. CARET was related to improved aerobic fitness, strength, physical functioning, QOL, and self-efficacy. At least one of the exercise interventions resulted in improvements in CD4+ cell count and HIV RNA viral load. Moreover, another study showed that HIV-specific biomarkers remained unchanged in the exercise intervention group, while they significantly worsened in the non-exercise group. In general, in spite of their well-known benefits, exercise programs have not been extensively utilized or widely recognized as viable therapeutic treatment options for this patient population. Knowing the possible health benefits of increasing physical activity level is important to better recommend exercise programs. However, the prescription must be done carefully and on an individual basis. Additional studies investigating the efficiency and effectiveness of different exercise training regimens for PLWH are needed.

Traditional games resulted in post-exercise hypotension and a lower cardiovascular response to the cold pressor test in healthy children.

The present study aimed to verify if blood pressure (BP) reactivity could be reduced through a previous single session of active playing when compared to sedentary leisure. Sixteen pre-pubertal healthy children participated in this study. After familiarization with procedures and anthropometric evaluation, participants performed three sessions in randomized order: (1) 30 min of traditional Brazilian games (PLAY); (2) 30 min of video game playing (DDR); and (3) 30 min of watching TV (TV). Each session lasted 80 min, being 10 min of rest; 30 min of intervention activity; and 40 min of recovery. After recovery, the Cold Pressor Test (CPT) was used for the assessment of acute cardiovascular reactivity. BP was recorded at 30 s and 1 min during the CPT. Analysis of variance showed post-exercise hypotension (PEH) only after PLAY, and that systolic and diastolic BP were significantly increased in all conditions during CPT. However, the magnitude of the CPT-induced BP response was significantly less in PLAY compared to DDR and TV. The PEH observed during recovery and the reduced BP response to CPT following playing traditional games may be due its higher cardiovascular and metabolic demand as was indicated by the increased heart rate, oxygen consumption, and BP. It was concluded that BP reactivity to stress may be reduced through a previous single session of traditional games and that PEH was recorded only after this exercise form. This benefit indicates a potential role of playing strategies for cardiovascular health in childhood.

The role of physical activity and heart rate variability for the control of work related stress.

Physical activity (PA) and exercise are often used as tools to reduce stress and therefore the risk for developing cardiovascular diseases (CVD). Meanwhile, heart rate variability (HRV) has been utilized to assess both stress and PA or exercise influences. The objective of the present review was to examine the current literature in regards to workplace stress, PA/exercise and HRV to encourage further studies. We considered original articles from known databases (PubMed, ISI Web of Knowledge) over the last 10 years that examined these important factors. A total of seven studies were identified with workplace stress strongly associated with reduced HRV in workers. Longitudinal workplace PA interventions may provide a means to improve worker stress levels and potentially cardiovascular risk with mechanisms still to be clarified. Future studies are recommended to identify the impact of PA, exercise, and fitness on stress levels and HRV in workers and their subsequent influence on cardiovascular health.

Exercise intensity modulates nitric oxide and blood pressure responses in hypertensive older women.

BACKGROUND AND AIMS: Whether intensity or other characteristics of physical activity can better promote the release of nitric oxide (NO) and reduction of blood pressure in hypertensive older-adults is still unknown. In this study, the post-exercise blood pressure (BP) response and NO release after different intensities of aerobic exercise in elderly women were analyzed. METHODS: Blood pressure response and NO were analyzed in 23 elderly mildly hypertensive women. Participants underwent (1) high-intensity incremental exercise (IT); (2) moderate-intensity 20 min exercise at 90% of the anaerobic threshold (AT), and (3) control (CONT) session. BP was measured before and after interventions; volunteers remained seated for 1 h. NO estimates were made through NO2- analyses. RESULTS: After CONT session, both diastolic BP and mean arterial pressure (MAP) were significantly higher than during pre-exercise resting. Post-exercise hypotension (PEH) was observed after exercise at IT and 90% of AT. Although exercise in both sessions lowered SBP and MAP compared with CONT, exercise at the highest intensity (IT) was more effective on lowering systolic BP after exercise. In comparison with pre-exercise resting, NO2- increased significantly only after IT, but both exercise sessions caused NO2- to increase compared with CONT. CONCLUSION: Exercise intensity and NO release may exert a role in eliciting PEH in mildly hypertensive elderly women.

Blood glucose control for individuals with type-2 diabetes: acute effects of resistance exercise of lower cardiovascular-metabolic stress.

This study compared the effects of resistance exercise (RE) intensities on blood glucose (GLUC) of individuals without (ND) and with type-2 diabetes (T2D). Nine individuals with T2D and 10 ND performed: (a) RE circuit at 23% of 1 maximal repetition (1RM) (RE_L); (b) RE circuit at 43% 1RM (RE_M); and (c) control (CON) session. Blood lactate (LAC) and GLUC were measured before, during, and postinterventions. Double product (DP) and rate of perceived exertion (RPE) were recorded. The area under the curve (AUC) revealed the effects of RE circuits in reducing GLUC in individuals with T2D (RE_L: 12,556 ± 3,269 vs. RE_M: 13,433 ± 3,054 vs. CON: 14,576 ± 3,922 mg.dl(-1).145 minutes; p < 0.05) with a lower AUC of GLUC in RE_L in comparison to RE_M. Similarly, for ND the RE_L reduced the AUC of GLUC when compared with RE_M and CON (RE_L: 10,943 ± 956 vs. RE_M: 12,156 ± 1,062 vs. CON: 11,498 ± 882 mg.dl(-1).145 minutes; p < 0.05). The AUC of GLUC was higher for T2D compared with ND on CON condition (p = 0.02). However, after RE circuits the difference between groups for AUC of GLUC was abolished. The RE_M for T2D was more stressful when compared with RE_L for LAC (CON: 1.3 ± 0.5 vs. RE_L: 5.5 ± 1.5 vs. RE_M: 6.8 ± 1.3 mmol·L(-1); p < 0.05), DP (CON: 8,415 ± 1,223 vs. RE_L: 15,980 ± 2,007 vs. RE_M: 18,047 ± 3,693 mmHg.bpm(-1); p < 0.05), and RPE (RE_L: 11 ± 2 vs. RE_M: 13 ± 2 Borg Scale; p < 0.05). We concluded that RE_L and RE_M were effective in reducing GLUC for individuals with T2D, with lower cardiovascular-metabolic and perceptual stress being observed for RE_L. These data suggest that acute RE sessions at light or moderate intensities are effective for controlling GLUC in individuals with T2D.

The higher exercise intensity and the presence of allele I of ACE gene elicit a higher post-exercise blood pressure reduction and nitric oxide release in elderly women: an experimental study.

BACKGROUND: The absence of the I allele of the angiotensin converting enzyme (ACE) gene has been associated with higher levels of circulating ACE, lower nitric oxide (NO) release and hypertension. The purposes of this study were to analyze the post-exercise salivary nitrite (NO2-) and blood pressure (BP) responses to different exercise intensities in elderly women divided according to their ACE genotype. METHODS: Participants (n = 30; II/ID = 20 and DD = 10) underwent three experimental sessions: incremental test - IT (15 watts workload increase/3 min) until exhaustion; 20 min exercise 90% anaerobic threshold (90% AT); and 20 min control session without exercise. Volunteers had their BP and NO2- measured before and after experimental sessions. RESULTS: Despite both intensities showed protective effect on preventing the increase of BP during post-exercise recovery compared to control, post-exercise hypotension and increased NO2- release was observed only for carriers of the I allele (p < 0.05). CONCLUSION: Genotypes of the ACE gene may exert a role in post-exercise NO release and BP response.

Physiological responses to a tap dance choreography: comparisons with graded exercise test and prescription recommendations.

The aim of this study was to analyze the physiological responses to a tap dance choreography and to compare with those observed during a maximal treadmill exercise test, in tap dancers. Eight women (19.6 +/- 2.4 years; 162.3 +/- 4.4 cm; 54.0 +/- 2.3 kg; 20.5 +/- 1.4 kg.m; and 5.1 +/- 2.6 years of tap dance training) were submitted to the following procedures: (a) graded exercise test (GXT) on a treadmill until volitional exhaustion with 0.8 km.h of increment at each 3 and 1 minute of interval between stages and (b) tap dance choreography (TAP)-"The Shim Sham Shimmy"-consisting of 9 stages of 3 minutes with 1-minute rest between stages. Expired gas analyses were performed in all experimental sessions, providing breath-by-breath values for respiratory exchange rate (RER), oxygen uptake (VO(2)), and carbon dioxide production (CO2). Heart rate (HR) and rate of perceived exertion (RPE) were also measured. During the rest period between stages, blood samples (25 microl) were collected from the ear lobe for lactate threshold (LT) determination. It was observed that at the end of the TAP, subjects achieved an average of 83.8 +/- 6.2% of the HRmax and 68.9 +/- 11.3% of the VO(2)max, both previously identified in the GXT. The choreography demanded 204.7 +/- 31.3 kcal, an average RER of 0.88 +/- 0.05 and mean RPE of 13 +/- 2. The VO(2), HR, and RPE values did not significantly differ from those at the LT intensity identified during the GTX. Based on the present results, it was concluded that the TAP performance in the "The Shim Sham Shimmy" choreography elicited acute physiologic responses similar to those observed at the LT intensity, thus suggesting that Tap Dance constitutes a useful exercise modality for aerobic fitness and cardiovascular health improvements.

[Methods to identify the anaerobic threshold for type-2 diabetic and non-diabetic subjects]. / Métodos para identificar o limiar anaeróbio em indivíduos com diabete tipo 2 e em indivíduos não-diabéticos.

BACKGROUND: In spite of Anaerobic Threshold (AT) to be widely used on exercise evaluation for different populations, there are few studies comparing methods to identify AT for individuals with type-2 diabetes. OBJECTIVE: To compare methods of AT determination on type-2 diabetics (T2D) and non-diabetic (ND) subjects and verify the acid-base balance as related to AT intensity. METHODS: T2D (n=10; 54.5+/-9.5 yr; 30.1+/-5.0 kg/m(2)) and younger ND (n=10; 36.6+/-12.8 yr; 23.9+/-5.0 kg/m(2)) performed an incremental test (IT) on a cycle ergometer. The over-proportional increase in VE/VO2 and blood lactate ([lac]) identified the ventilatory (VT) and lactate thresholds (LT) respectively. The workload corresponding to the lower blood glucose ([gluc]) during test identified the individual glucose threshold (IGT). The AT was also determined by polynomial adjustment of the VE/Workload and [lac]/Workload responses to identify exercise intensities above which an over-proportional increase in VE and [lac] did occur and were named VT VE/W and LT[lac]/W. RESULTS: The workload (Watts-W) corresponding to LT, VT, IGT, LT Lac/W and VT VE/W of diabetics (85.0+/-32.1; 88.0+/-31.7; 86.0+/-33.8; 82.0+/-20.9 and 90.2+/-22.2W) and non-diabetics (139.0+/-39.0; 133.0+/-42.7; 140.8+/-36.4; 122.7+/-44.3 and 133.0+/-39.1W) differed between groups (p<0.001), but not within groups. Thus it was evidenced an agreement among the studied methods. The pH and pCO2 were significantly decreased in parallel to the increase in [lac], pO2 and VE at supra AT intensities. CONCLUSION: The AT intensities, as determined by different methods both for diabetics and non-diabetic individuals, were in agreement to each other and identified exercise intensities above which the acid-basic balance is disrupted.

Postresistance exercise blood pressure reduction is influenced by exercise intensity in type-2 diabetic and nondiabetic individuals.

This study analyzed the postexercise blood pressure (BP) after resistance exercise (RE) on middle-aged type-2 diabetic (T2DM, n = 10, 46.6 +/- 13.1 years) and nondiabetic subjects (NDM, n = 10, 52.0 +/- 13.2 years). Participants performed (a) 1 repetition maximum (1RM) strength test; (b) 3 laps in an RE circuit of 6 exercises (16 repetitions at 43% 1RM); (c) 3 laps in an RE circuit (30 repetitions at 23% 1RM); and (d) a control session. The blood lactate concentration ([lac]) (YSI 2700S) and BP (Microlife BP3AC1-1) were measured pre-exercise, after exercise, and at each 15 minutes during the 120 minutes of recovery. Analysis of variance with Bonferroni as a post hoc evidenced that the 43% 1RM session elicited the highest [lac] response for both NDM (7.8 +/- 1.8 vs. 6.4 +/- 1.8 mmol x L(-1); p < 0.05) and T2DM (7.0 +/- 1.4 vs. 5.6 +/- 1.6 mmol x L(-1); p < 0.05). Also, the 43% 1RM session promoted a significant postexercise hypotension (PEH) of systolic blood pressure (SBP) and mean arterial pressure (MAP), whereas the 23% 1RM did not. The highest BP reductions for T2DM and NDM after 43% 1RM were, respectively, 9.5 +/- 11.1 and 11.0 +/- 7.1 mmHg for SBP and 6.4 +/- 7.8 and 7.7 +/- 7.9 mmHg for the MAP (p

Validade de equações de predição em estimar o VO2max de brasileiros jovens a partir do desempenho em corrida de 1.600m / Predictive equations validity in estimating the VO2max of young Brazilians from performance in a 1600 m run

O objetivo deste estudo foi analisar a validade da equação proposta por Cureton et al. (1995) "VO2peak = -8.41 (MRW) + 0.34 (MRW)2 + 0.21 (Age x Gender) -0.84 (BMI) + 108.94" em estimar o VO2max de brasileiros jovens a partir de um teste de 1.600 metros, e sugerir uma equação de predição que seja específica para essa população. Participaram do estudo 30 homens fisicamente ativos (23 ± 3,1anos; 74,8 ± 5,8kg; 1,78 ± 0,05m; 49,8 ± 6,5mL.kg-Õ.min-1) que foram submetidos a um teste incremental máximo (TI) em esteira e um teste de desempenho em corrida de 1.600 metros. Os indivíduos foram divididos em dois grupos: G1 - para gerar uma equação de predição específica para VO2max de brasileiros jovens e G2 - para aplicar ambas as equações a fim de analisar suas validades. Diferenças estatisticamente significativas foram observadas entre o VO2max determinado diretamente no TI (50,1 ± 7,1mL.kg-Õ.min-Õ) e os valores de VO2max obtidos pela equação proposta por Cureton et al. (44,2 ± 6,5mL.kg-Õ.min-Õ) com baixa correlação entre elas (r = 0,21). A relação entre VO2max e velocidade em corrida de 1.600m obtidos no G1 resultou na seguinte equação de predição: (VO2max = 0,177 * 1.600Vm(m.min-1) + 8,101). Quando essa nova equação foi aplicada nos participantes do G2, o VO2max predito (50,1 ± 7,2mL.kg-Õ.min-Õ) não diferiu do VO2max determinado diretamente (50,1 ± 7,1mL.kg-Õ.min-Õ) com alta correlação entre eles (r = 0,81). Assim, concluímos que a equação de Cureton et al. (1995), elaborada a partir de resultados de amostra norte-americana, subestimou o VO2max de brasileiros jovens e fisicamente ativos. Por outro lado, a equação proposta no presente estudo se mostrou válida para estimar o VO2max através do teste de desempenho de 1.600 metros para a população estudada.

The aim of the present study was to analyze the validity of predictive equation proposed by Cureton et al. (1995) for VO2peak = -8.41 (MRW) + 0.34 (MRW) 2 + 0.21 (Age x Gender) -0.84 (BMI) + 108.94" on estimating the VO2max of young Brazilians from a 1600-m running performance, and to suggest a predictive equation specific for this population. 30 physically active young men (23±3.1age; 74.8±5.8kg; 1.78±0.05m; 49.8±6.5mL.kg-Õ.min-1) who were submitted to an incremental exercise test (IT) on treadmill until exhaustion with gas analysis participated in this study. Subjects also performed a 1600-m running track test as fast as possible. The volunteers were randomly sorted in two groups: G1 - to generate a specific predictive equation for VO2max, and G2 - to apply both predictive equations (actual and from Cureton et al.) to evaluate their validity on estimating VO2max in a Brazilian population sample. Significant differences were observed between VO2max directly identified on IT through gas analysis (50.1±7.1 mL.kg-Õ.min-Õ) in relation to the results obtained by the predictive equation proposed by Cureton et al. (1995) (44.2±6.5mL.kg-Õ.min-Õ) with a weak relationship between them (r = 0.21). The relationship between the VO2max on IT and the running velocity on 1600-m as obtained for G1 resulted in the following predictive equation: (VO2max = 0.177*1600Vm(m.min-1) + 8,101). When this new equation was applied on the participants of G2, the predicted VO2max (50.1±7.2mL.kg-Õ.min-Õ) did not differ from VO2max determined directly on IT (50.1±7.1mL.kg-Õ.min-Õ) with a high correlation between them (r = 0.81). Thus, it was concluded that the Cureton et al. predictive equation developed with a North Americanpopulation sample as grounding, underestimated the VO2max of physically active young Brazilians. On the other hand, the predictive equation proposed on the present study was considered valid for this purpose through the 1600-m running performance...

Métodos para identificar o limiar anaeróbio em indivíduos com diabete tipo 2 e em indivíduos não-diabéticos / Methods to identify the anaerobic threshold for type-2 diabetic and non-diabetic subjects / Métodos para identificar el umbral anaeróbico en individuos con diabetes tipo 2 y en individuos no diabéticos

Fundamento: Apesar de o limiar anaeróbio (LAn) ser utilizado na avaliação funcional de diferentes populações, estudos comparando métodos para sua identificação em diabéticos tipo-2 tem sido pouco realizados. Objetivo: Comparar protocolos de identificação do LAn em indivíduos diabéticos tipo 2 e em não-diabéticos, e analisar respostas relacionadas ao equilíbrio ácido-básico em intensidades relativas ao LAn. MÉTODOS: Diabéticos tipo 2 (n=10; 54,5±9,5 anos; 30,1±5,0 kg/m²) e jovens não-diabéticos (n=10; 36,6±12,8 anos; 23,9±5,0 kg/m²) realizaram teste incremental (TI) em ciclo ergômetro. O aumento desproporcional no equivalente ventilatório de oxigênio (VE/VO2) e lactatemia ([lac]) identificaram intensidades (Watts-W) correspondentes aos limiares ventilatório (LV) e de lactato (LL), respectivamente. A intensidade correspondente à menor glicemia ([glic]) foi considerada limiar glicêmico individual (LGI). O LAn também foi determinado por ajuste polinomial das razões VE/Watts (LV VE/W) e [lac]/Watts (LL[lac]/W), as quais identificaram intensidades acima das quais um aumento desproporcional na VE e [lac] ocorreram. Resultados: Não foram observadas diferenças entre LL, LV, LG, LL[lac]/W e LV VE/W em diabéticos (85,0±32,1; 88,0±31,7; 86,0±33,8; 82,0±20,9 e 90,2±22,2W) e não-diabéticos (139,0±39,0; 133,0±42,7; 140,8±36,4; 122,7±44,3 e 133,0±39,1W). Contudo os valores de LAn diferiram significativamente entre grupos (p<0.001). A técnica de Bland-Altman confirmou concordância entre os protocolos. Reduções significativas no pH e pCO2 em paralelo a um aumento na [lac], pO2 e VE foram observadas em intensidades supra limiares. Conclusão: Os protocolos apresentaram, para ambos os grupos estudados, concordância na identificação do LAn, que se mostrou como uma intensidade de exercício acima da qual ocorre perda de equilíbrio ácido-básico.

Background: In spite of Anaerobic Threshold (AT) to be widely used on exercise evaluation for different populations, there are few studies comparing methods to identify AT for individuals with type-2 diabetes. Objective: To compare methods of AT determination on type-2 diabetics (T2D) and non-diabetic (ND) subjects and verify the acid-base balance as related to AT intensity. METHODS: T2D (n=10; 54.5±9.5 yr; 30.1±5.0 kg/m²) and younger ND (n=10; 36.6±12.8 yr; 23.9±5.0 kg/m²) performed an incremental test (IT) on a cycle ergometer. The over-proportional increase in VE/VO2 and blood lactate ([lac]) identified the ventilatory (VT) and lactate thresholds (LT) respectively. The workload corresponding to the lower blood glucose ([gluc]) during test identified the individual glucose threshold (IGT). The AT was also determined by polynomial adjustment of the VE/Workload and [lac]/Workload responses to identify exercise intensities above which an over-proportional increase in VE and [lac] did occur and were named VT VE/W and LT[lac]/W. Results: The workload (Watts-W) corresponding to LT, VT, IGT, LT Lac/W and VT VE/W of diabetics (85.0±32.1; 88.0±31.7; 86.0±33.8; 82.0±20.9 and 90.2±22.2W) and non-diabetics (139.0±39.0; 133.0±42.7; 140.8±36.4; 122.7±44.3 and 133.0±39.1W) differed between groups (p<0.001), but not within groups. Thus it was evidenced an agreement among the studied methods. The pH and pCO2 were significantly decreased in parallel to the increase in [lac], pO2 and VE at supra AT intensities. Conclusion: The AT intensities, as determined by different methods both for diabetics and non-diabetic individuals, were in agreement to each other and identified exercise intensities above which the acid-basic balance is disrupted.

Fundamento: A pesar de que el umbral anaeróbico (UAn) se utiliza en la evaluación funcional de diferentes poblaciones, pocos estudios que comparen métodos para su identificación en diabéticos tipo 2 están siendo realizados. Objetivo: Comparar protocolos de identificación del UAn en individuos diabéticos tipo 2 y en no diabéticos, y analizar respuestas relacionadas al equilibrio ácido-base en intensidades relativas al UAn. MÉTODOS: Diabéticos tipo 2 (n=10; 54,5±9,5 años; 30,1±5,0 kg/m²) y jóvenes no diabéticos (n=10; 36,6±12,8 años; 23,9±5,0 kg/m²) realizaron un test incremental (TI) en ciclo ergómetro. El aumento desproporcionado en el equivalente ventilatorio de oxígeno (VE/VO2) y lactatemia ([lac]) identificó intensidades (Watts-W) correspondientes a los umbrales ventilatorio (UV) y de lactato (UL), respectivamente. La intensidad correspondiente a la menor glucemia ([gluc]) se consideró umbral glucémico individual (UGI). El UAn también fue determinado por ajuste polinomial de las razones VE/Watts (UV VE/W) y [lac]/Watts (UL[lac]/W), las que identificaron intensidades por encima de las cuales ocurriera un aumento desproporcionado en la VE y [lac]. Resultados: No se observaron diferencias entre UL, UV, UG, UL[lac]/W y UV VE/W en diabéticos (85,0±32,1; 88,0±31,7; 86,0±33,8; 82,0±20,9 y 90,2±22,2W) y no diabéticos (139,0±39,0; 133,0±42,7; 140,8±36,4; 122,7±44,3 y 133,0±39,1W). Sin embargo, los valores de UAn difirieron significativamente entre los grupos (p<0.001). La técnica de Bland-Altman confirmó una concordancia entre los protocolos. En las intensidades sobre los umbrales se observaron reducciones significativas en el pH y pCO2 paralelamente a un aumento en la [lac], pO2 y VE. Conclusión: Los protocolos presentaron, para ambos grupos estudiados, concordancia en la identificación del UAn, que se mostró como una intensidad de ejercicio, por encima de la cual ocurre pérdida de equilibrio ácido-base.

Effects of treadmill running and resistance exercises on lowering blood pressure during the daily work of hypertensive subjects.

The purposes of this study were to compare the hypotensive effects of treadmill running (TR) and resistance exercise (RE) performed by hypertensive subjects and to verify if the hypotensive effects of these exercises are maintained during a regular white-collar workday. Fifteen white-collar workers (42.9 +/- 1.6 years), treated with antihypertensive medication, accomplished three different sessions: 20 minutes of TR (approximately 70-80% of heart rate reserve), 20 minutes of circuit training RE (20 repetitions at 40% of 1 repetition maximum), and a control session without exercise (CON). The systolic blood pressure (BP), diastolic BP, heart rate, and blood lactate were measured at resting (Rest) and after sessions at 15th (R15), 30th (R30), 45th (R45), and 60th (R60) min, as well as after lunch (AL), four (R4h) and seven (R7h) hours of recovery at the participants' workplace. In relation to rest, a higher decrease of systolic BP after TR (-11.1 +/- 7.6 mm Hg) and RE (-12.6 +/- 7.3 mm Hg) was observed respectively at the R30 and R45. For diastolic BP, the highest decreases after TR (-4.0 +/- 6.4 mm Hg) and RE (-9.0 +/- 7.0 mm Hg) were observed respectively at the R45 and R30. The systolic BP and mean BP after TR and RE differed significantly from CON session (p < 0.05), and lower post-exercise values could be observed over the workday. In conclusion, both 20 minutes of TR and RE resulted in postexercise hypotension, and were able to reduce BP throughout 7 hours after exercise, even throughout the subject's regular occupational activities. Also, the RE promoted higher cardiac protection and can be a useful model of physical exercise prescription for hypertension individuals.

Methods to identify the lactate and glucose thresholds during resistance exercise for individuals with type 2 diabetes.

The purpose of this study was to compare different methods to identify the lactate threshold (LT) and glucose threshold (GT) on resistance exercise for individuals with type 2 diabetes. Nine men with type 2 diabetes (47.2 +/- 12.4 years, 87.6 +/- 20.0 kg, 174.9 +/- 5.9 cm, and 22.4 +/- 7.2% body fat) performed incremental tests (ITs) on the leg press (LP) and bench press (BP) at relative intensities of 10, 20, 25, 30, 35, 40, 50, 60, 70, 80, and 90% of one-repetition maximum (1RM) at each 1-minute stage. During the 2-minute interval between stages, 25 mul of capillary blood were collected from the earlobe for blood lactate [Lac] and blood glucose [Gluc] analysis (YSI 2700S). The LT in the LP and BP was identified at IT by the inflexion in [Lac] response as well as by an equation originated from a polynomial adjustment (LTp) of the [Lac]/% 1RM ratio responses. The lowest [Gluc] during the IT identified the GT. The analysis of variance did not show differences among the 1RM at the thresholds identified by different methods in the LP (LTLP = 31.0% +/- 5.3% 1RM; GTLP = 32.1% +/- 6.1% 1RM; LTpLP = 36.7% +/- 5.6% 1RM; p > 0.05) and BP (LTBP = 29.9% +/- 8.5% 1RM; GTBP = 32.1% +/- 8.5% 1RM; LTpBP = 31.8% +/- 6.7% 1RM; p > 0.05). It was concluded that it was possible to identify the LT and GT in resistance exercise by different methods for individuals with type 2 diabetes with no differences between them. The intensities (kg) corresponding to these thresholds were between 46% and 60% of the body weight on the LP and between 18% and 26% of the body weight on the BP, in which the exercise prescription would be done to this intensity in 3 sets of 20 to 30 repetitions each and 1 minute of rest while alternating the muscle groups for blood glucose control for individuals with characteristics similar to the participants.

Hypotensive effects of exercise performed around anaerobic threshold in type 2 diabetic patients.

AIM: To verify the occurrence of post-exercise hypotension (PEH) in type 2 diabetics (DM(2)) and the effects of exercise intensity on post-exercise blood pressure (BP). METHODS: Eleven men and women with DM(2) (58.5+/-10.2 years; 160+/-0.1cm; 80.6+/-13.5kg; 31.2+/-3.8kg/m(2), 19+/-3.2mLkgmin(-1) of VO(2max), 155.0+/-39.2mgdL(-1) of fasting blood glucose and 126+/-10/75+/-7mmHg of resting BP) performed an incremental test (IT) for cardiovascular evaluation and anaerobic threshold (AT) determination. Then, participants randomly underwent 2 exercise sessions (90% and 110% AT) and a control session (CON). In all sessions, BP was measured at resting, during 20min of exercise/control and at each 15min through 120min of post-exercise recovery (R15-R120). RESULTS: The mean results of systolic BP (SBP)/diastolic BP (DBP) over the 120min of recovery were 125+/-16/76+/-7mmHg, 122+/-13/75+/-6mmHg and 129+/-16/78+/-7mmHg, respectively for 90%, 110% and CON. Significant reductions of SBP occurred after 90% (R15-R45) and 110% (R15-R90), while only after 110% there were reductions of DBP (R15, R45) and MAP (R15, R45, R75, R90, R105). CONCLUSIONS: Both exercise intensities evoked reductions in SBP while DBP and MAP were reduced only after 110%. Despite the higher intensity exercise to be more effective in promoting BP reductions, we suggest caution while prescribing exercise for DM(2).

Predição da resistência à insulina em crianças: indicadores antropométricos e metabólicos / Predicting insulin resistance in children: anthropometric and metabolic indicators

OBJETIVO: Predizer a resistência à insulina em crianças a partir de indicadores antropométricos e metabólicos por análise de sensibilidade e especificidade dos pontos de corte. MÉTODOS: Estudo transversal foi realizado em 109 crianças de 7 a 11 anos, sendo 55 obesas, 23 sobrepesadas e 31 eutróficas, classificadas pelo índice de massa corporal (IMC) para idade. Foram medidos IMC, circunferências da cintura e quadril, razão circunferência da cintura/circunferência do quadril, índice de conicidade e percentual de gordura (absortometria de raio X de dupla energia). Coleta sangüínea em jejum foi realizada para mensuração da trigliceridemia, glicemia e insulinemia. A resistência à insulina foi avaliada pelo método homeostase glicêmica, considerando-se o percentil 90 como ponto de corte. Na identificação dos preditores de homeostase glicêmica, foi adotada a análise das curvas receiver operating characteristic com intervalo de confiança de 95 por cento, calculando-se posteriormente a sensibilidade e especificidade. RESULTADOS: Os indicadores com poder de predição da resistência à insulina analisando a área sob a curva receiver operating characteristic (intervalo de confiança), com respectivos pontos de corte, foram, nesta ordem: insulinemia = 0,99 (0,99-1,00), 18,7 µU×mL-1; percentual de gordura = 0,88 (0,81-0,95), 41,3 por cento; IMC = 0,90 (0,83-0,97), 23,69 kg×m²-¹; circunferência da cintura = 0,88 (0,79-0,96), 78,0 cm; glicemia = 0,71 (0,54-0,88), 88,0 mg×dL-1; trigliceridemia = 0,78 (0,66-0,90), 116,0 mg×dL-1 e índice de conicidade = 0,69 (0,50-0,87), 1,23 para amostra total; e insulinemia = 0,99 (0,98-1,00), 19,54 µU×mL-1; percentual de gordura = 0,76 (0,64-0,89), 42,2 por cento; IMC = 0,78 (0,64-0,92), 24,53 kg×m²-¹; circunferência da cintura = 0,77 (0,61-0,92), 79,0 cm e trigliceridemia = 0,72 (0,56-0,87), 127,0 mg×dL-1 para os obesos. CONCLUSÕES: Indicadores antropométricos e metabólicos...

OBJECTIVE: To predict insulin resistance in children based on anthropometric and metabolic indicators by analyzing the sensitivity and specificity of different cutoff points. METHODS: A cross-sectional study was carried out of 109 children aged 7 to 11 years, 55 of whom were obese, 23 overweight and 31 well-nourished, classified by body mass index (BMI) for age. Measurements were taken to determine BMI, waist and hips circumferences, waist circumference/hip circumference ratio, conicity index and body fat percentage (dual emission X-ray absorptiometry). Fasting blood samples were taken to measure triglyceridemia, glycemia and insulinemia. Insulin resistance was evaluated by the glycemic homeostasis method, taking the 90th percentile as the cutoff point. Receiver operating characteristic curves were analyzed to a 95 percent confidence interval in order to identify predictors of glycemic homeostasis, and sensitivity and specificity were then calculated. RESULTS: After analysis of the area under the receiver operating characteristic curve (confidence interval), indicators that demonstrated the power to predict insulin resistance were, in the following order: insulinemia = 0.99 (0.99-1.00), 18.7 µU×mL-1; body fat percentage = 0.88 (0.81-0.95), 41.3 percent; BMI = 0.90 (0.83-0.97), 23.69 kg×m2-¹; waist circumference= 0.88 (0.79-0.96), 78.0 cm; glycemia = 0.71 (0.54-0.88), 88.0 mg×dL-1; triglyceridemia = 0.78 (0.66-0.90), 116.0 mg×dL-1 and conicity index = 0.69 (0.50-0.87), 1.23 for the whole sample; and were: insulinemia = 0.99 (0.98-1.00), 19.54 µU×mL-1; body fat percentage = 0.76 (0.64-0.89), 42.2 percent; BMI = 0.78 (0.64-0.92), 24.53 kg×m2-¹; waist circumference = 0.77 (0.61-0.92), 79.0 cm and triglyceridemia = 0.72 (0.56-0.87), 127.0 mg×dL-1, for the obese subgroup. CONCLUSIONS: Anthropometric and metabolic indicators appear to offer good predictive power for insulin resistance in children...

Predicting insulin resistance in children: anthropometric and metabolic indicators.

OBJECTIVE: To predict insulin resistance in children based on anthropometric and metabolic indicators by analyzing the sensitivity and specificity of different cutoff points. METHODS: A cross-sectional study was carried out of 109 children aged 7 to 11 years, 55 of whom were obese, 23 overweight and 31 well-nourished, classified by body mass index (BMI) for age. Measurements were taken to determine BMI, waist and hips circumferences, waist circumference/hip circumference ratio, conicity index and body fat percentage (dual emission X-ray absorptiometry). Fasting blood samples were taken to measure triglyceridemia, glycemia and insulinemia. Insulin resistance was evaluated by the glycemic homeostasis method, taking the 90th percentile as the cutoff point. Receiver operating characteristic curves were analyzed to a 95% confidence interval in order to identify predictors of glycemic homeostasis, and sensitivity and specificity were then calculated. RESULTS: After analysis of the area under the receiver operating characteristic curve (confidence interval), indicators that demonstrated the power to predict insulin resistance were, in the following order: insulinemia = 0.99 (0.99-1.00), 18.7 microU mL(-1); body fat percentage = 0.88 (0.81-0.95), 41.3%; BMI = 0.90 (0.83-0.97), 23.69 kg m(2-(1)); waist circumference= 0.88 (0.79-0.96), 78.0 cm; glycemia = 0.71 (0.54-0.88), 88.0 mg dL(-1); triglyceridemia = 0.78 (0.66-0.90), 116.0 mg dL(-1) and conicity index = 0.69 (0.50-0.87), 1.23 for the whole sample; and were: insulinemia = 0.99 (0.98-1.00), 19.54 microU mL(-1); body fat percentage = 0.76 (0.64-0.89), 42.2%; BMI = 0.78 (0.64-0.92), 24.53 kg m(2-(1)); waist circumference = 0.77 (0.61-0.92), 79.0 cm and triglyceridemia = 0.72 (0.56-0.87), 127.0 mg dL(-1), for the obese subgroup. CONCLUSIONS: Anthropometric and metabolic indicators appear to offer good predictive power for insulin resistance in children between 7 and 11 years old, employing the cutoff points with the best balance between sensitivity and specificity of the predictive technique.