Acute effects of exercise with blood flow restriction on endothelial function in healthy young and older populations: a systematic review / Efeitos agudos do exercício com restrição do fluxo sanguíneo na função endotelial de jovens e idosos saudáveis: uma revisão sistemática

The objective of this review is to identify the acute effects of blood flow restriction (BFR) with vs without exercise on endothelial function in healthy individuals and the changes in endothelial function in young and older adults following different levels of exclusive BFR vs free flow. Systematic searches were performed in the following databases: PubMed, Web of Science, Scopus, and Cochrane Library, from inception to July 17, 2021. The studies included healthy individuals who underwent assessments of endothelial function before and after experimental protocols through endothelium-dependent flow-mediated dilatation. In total, 4890 studies were screened, and 6 studies of moderate-to-high methodological quality (Physiotherapy Evidence Database scores 6 ­ 10) including 82 subjects (aged 24 ­ 68 years) were eligible. Overall, flow-mediated dilatation increased in the non-cuffed arm immediately and 15 minutes after exercise, with no change in the cuffed arm (BFR of 60 ­ 80 mmHg). In protocols without exercise, cuff pressures of 25 ­ 30 mmHg applied for 30 minutes did not promote changes in the endothelial function, while those > 50 mmHg induced a dose-dependent attenuation of flow-mediated dilatation only in young individuals. A moderate level of BFR appears to have no effect on endothelial function after acute exercise. In non-exercise conditions, reductions in flow-mediated dilatation seem to result from increased retrograde shear provoked by cuff pressures ≥ 50 mmHg in young but not in older adults. An exercise-related increase in antegrade shear rate leads to a greater nitric oxide-mediated vasodilator response. However, BFR appears to attenuate this effect in young but not in older individuals. (AU)

O objetivo desta revisão foi identificar os efeitos agudos da restrição do fluxo sanguíneo (RFS) com vs. sem exercício na função endotelial de indivíduos saudáveis, bem como as alterações na função endotelial em jovens e idosos após diferentes níveis de RFS vs. fluxo livre. Pesquisas sistemáticas foram realizadas nas bases United States National Library of Medicine (PubMed), Web of Science, Scopus e Cochrane Library até 17 de julho de 2021. Os estudos incluíram indivíduos saudáveis que avaliaram a função endotelial antes e após protocolos experimentais, por meio da dilatação mediada por fluxo. Foi selecionado o total de 4.890 estudos, e foram elegíveis seis de moderada a alta qualidade metodológica (Physioterapy Evidence Database 6 ­ 10 pontos), incluindo 82 indivíduos (24 ­ 68 anos). No geral, a dilatação mediada por fluxo aumentou no braço sem manguito, imediatamente e 15 minutos após o exercício, sem alteração no braço com manguito (RFS de 60 ­ 80 mmHg). Em protocolos sem exercício, pressões do manguito de 25 ­ 30 mmHg aplicadas por 30 minutos não promoveram alterações na função endotelial, enquanto aquelas > 50 mmHg induziram uma atenuação dose-dependente da dilatação mediada por fluxo em indivíduos jovens. Um nível moderado de RFS parece não ter efeito na função endotelial após uma sessão de exercício. Em condições sem exercício, as reduções na dilatação mediada por fluxo parecem resultar do aumento do cisalhamento retrógrado provocado por pressões do manguito ≥ 50 mmHg em jovens, mas não em idosos. O aumento da taxa de cisalhamento anterógrado relacionada ao exercício leva a maior resposta vasodilatadora mediada pelo óxido nítrico. No entanto, a RFS parece atenuar esse efeito em jovens, mas não em . (AU)

Exercise with blood flow restriction improves muscle strength and mass while preserving the vascular and microvascular function and structure of older adults.

BACKGROUND: Changes in muscle mass, strength, vascular function, oxidative stress, and inflammatory biomarkers were compared in older adults after resistance training (RT) performed with low-intensity without blood flow restriction (RT-CON); low-intensity with BFR (RT-BFR); and high-intensity without BFR (RT-HI). METHODS: Thirty-two untrained individuals (72±7 y) performed a 12-week RT after being randomized into three groups: RT-CON -30% of 1 repetition maximum (RM); RT-BFR -30% of 1RM and mild BFR (50% of arterial occlusion pressure); RT-HI -70% of 1 RM. RESULTS: Improvements in handgrip strength were similar in RT-BFR (17%) and RT-HI (16%) vs. RT-CON (-0.1%), but increases in muscle mass (6% vs. 2% and -1%) and IGF-1 (2% vs. -0.1% and -1.5%) were greater (p < 0.05) in RT-BFR vs. RT-HI and RT-CON. Changes in vascular function, morphology, inflammation, and oxidative stress were similar between groups, except for time to reach maximum red blood cell velocity which showed a greater reduction (p < 0.05) in RT-BFR (-55%) vs. RT-HI (-11%) and RT-CON (-4%). CONCLUSION: RT with low intensity and mild BFR improved muscle strength and mass in older individuals while preserving vascular function. This modality should be considered an adjuvant strategy to improve muscle function in older individuals with poor tolerance to high loads.

Sarcopenia in the elderly versus microcirculation, inflammation status, and oxidative stress: A cross-sectional study.

BACKGROUND: Age-related mechanisms of sarcopenia associated with vascular function have been recently suggested. This study compared and tested associations between muscle mass and strength, microcirculation, inflammatory biomarkers, and oxidative stress in older adults classified as sarcopenic and non-sarcopenic. METHODS: Thirty-three physically inactive individuals (72±7 yrs) were assigned to age-matched sarcopenic (SG) and non-sarcopenic (NSG) groups. Between-group comparisons were performed for appendicular skeletal mass (ASM), handgrip and isokinetic strength, microvascular function and morphology, C-reactive protein, insulin-like growth factor-1, tumor necrosis factor-alpha, interleukin-6 (IL-6), soluble vascular cell adhesion molecule-1, soluble intercellular adhesion molecule-1, endothelin-1, and oxidized low-density lipoprotein. RESULTS: ASM and knee isokinetic strength were lower in SG than NSG (P < 0.05). No difference between groups was found for outcomes of microvascular function and morphology, but log-transformed IL-6 concentration was twice greater in SG vs. NSG (P = 0.02). Correlations between ASM index, handgrip and knee isokinetic strength vs. markers of microcirculatory function, capillary diameters, vascular reactivity, and endothelial injury were found only in SG. CONCLUSION: Decreased ASM index and strength have been associated with microcirculatory profile, indicating that microcirculation impairment may be involved somehow in Sarcopenia development. The inflammation status, particularly elevated IL-6, seems to play an important role in this process.

Muscle mass, strength, bone mineral density and vascular function in middle-aged people living with HIV vs. age-matched and older controls.

INTRODUCTION: Combination antiretroviral therapy (cART) substantially extended the life of people living with HIV (PLHIV). However, prolonged HIV infection and cART increase the risk of comorbidities accelerating age-related muscle, bone, and vascular disorders. This cross-sectional study compared muscle mass and strength, bone mineral density (BMD), and vascular function in middle-aged PLHIV treated with cART vs. non-infected age-matched and older controls. METHODS: After careful screening for secondary diseases and medications, body composition, muscular and vascular function were assessed in 12 PLHIV (43.9±8.7 yrs old; HIV-infection for 16.2±8.6 yrs; on cART for 11.6±9.2 yrs), 12 age-matched (CONT, 43.2±8.5 yrs old), and 12 older (OLDER, 74.4±8.3 yrs old) controls through dual x-ray absorptiometry, isokinetic dynamometry, and venous occlusion plethysmography, respectively. RESULTS: PLHIV and CONT showed similar relative muscle mass (65.3±8.0 vs. 66.9±7.3%, respectively; P= 0.88) and strength (160.7±53.9 vs. 152.0±52.9 N.m-1, respectively; P= 0.90), which were greater than OLDER (80.6±18.8 N.m-1; P= 0.001). Total BMD was similar in PLHIV (1.04±0.13 g.cm-2) and OLDER (1.00±0.15 g.cm-2, P= 0.86), and both groups presented lower values than CONT (1.20±0.13 g.cm-2, P< 0.01). No significant difference across groups was detected for macrovascular reactivity (P= 0.32). CONCLUSION: Age-related osteopenia might be accelerated in middle-aged PLHIV on prolonged cART, as their BMD approached values found in older adults. On the other hand, muscle mass, isokinetic strength, and vasodilation capacity were similar in PLHIV and age-matched uninfected controls.

Does Resistance Training with Blood Flow Restriction Affect Blood Pressure and Cardiac Autonomic Modulation in Older Adults?

Resistance training (RT) with blood flow restriction (BFR) appears to accelerate muscle hypertrophy and strength gains in older populations. However, the training-related effects of RT with BFR upon blood pressure (BP) and cardiac autonomic modulation in the elderly remains unclear. The objective of this study is to compare the chronic effects of low-intensity RT performed with soft BFR (BFR) vs. high-intensity (HI) and low-intensity RT (CON) without BFR on BP and heart rate variability (HRV) indices in older adults. Thirty-two physically inactive participants (72 ± 7 yrs) performed RT for upper and lower limbs (50-min sessions, 3 times/week) for 12 weeks, being assigned into three groups: a) BFR; 30% of 1 repetition maximum (RM) with BFR corresponding to 50% of arterial occlusion pressure; b) HI; 70% of 1RM without BFR; c) CON; 30% of 1 RM without BFR. Resting BP and HRV were assessed at rest in the supine position, before and after exercise interventions. Systolic BP (Δ = -7.9 ± 8.0 mmHg; p = 0.002; effect size = 0.62), diastolic BP (Δ = trace length by the duration of the test 5.0 ± 6.0 mmHg; p = 0.007; effect size = 0.67) and mean arterial pressure (Δ = -6.3 ± 6.5 mmHg; p = 0.003/effect size = 0.77) reduced after BFR, remaining unaltered in HI and CON. HRV indices of sympathetic and vagal modulation did not change in all groups (p ≥ 0.07 for all comparisons). 12-wk RT with low intensity and relatively soft BFR substantially reduced BP at rest in older adults vs. traditional RT performed with either low or high intensity. Those reductions were not parallel to changes in autonomic modulation.

Ciências da atividade física como protagonista de uma agenda multisetorial de pesquisa e advocacy na promoção da mobilidade ativa / Physical activity sciences as protagonist of a multisectoral agenda in the promotion of active transportation

No epicentro da pandemia, as cidades enfrentam desafios econômicos e na saúde. Para lidar com a crise e reduzir os riscos de infecção nos transportes coletivos, o uso de transportes ativos passou a receber atenção de governos locais. Adotando como referencial o conceito de "Saúde em Todas as Políticas", o presente ensaio teórico teve como objetivo discutir oportunidades causadas pela pandemia da COVID-19, considerando as relações entre o uso de transportes ativos e seus impactos sobre a prevenção de doenças crônicas não transmissíveis, a mobilidade urbana e o meio-ambiente. Dentro deste contexto, destacamos a importância de se mensurar as influências e externalidades da indústria automotiva, caracterizando-a como um ator a ser enfrentado nas políticas de promoção da saúde e mobilidade ativa. Neste sentido, acreditamos que as Ciências da Atividade Física podem exercer um protagonismo na formação de uma agenda multisetorial de pesquisa e advocacy, que objetivem reorientar os sistemas de transporte, de desenho urbano e de uso do solo

At the epicenter of the pandemic, cities face economic and health challenges. In order to deal with the crisis and reduce the risks of infection in public transport, the use of active modes of transportation has received attention from local governments. Adopting the concept of "Health in All Policies" as a reference, this theoret-ical essay aimed to discuss opportunities caused by the pandemic of COVID-19, considering the relationship between the use of active transportation and its impacts on the prevention of non-communicable diseases, urban mobility and the environment. Within this context, we highlight the importance of measuring the ex-ternalities of the automotive industry, characterizing it as an actor to be fought in policies to promote health and active transportation. In this sense, we believe that the Physical Activity Sciences can play a leading role in the formation of a multisectoral agenda for research and advocacy, which aims to reorient the transport, urban design and land use systems

A essencialidade das academias de ginástica para a saúde diante da pandemia da COVID-19 no Brasil / The essentiality of gyms for health in the face of the COVID-19 Pandemic in Brazil

Em maio de 2020, por decreto presidencial, as academias foram incluídas no rol de atividades essenciais. Embora o decreto presidencial não tenha sido adotado por muitos estados e municípios, pressões e posicionamentos em favor da reabertura do setor têm ocorrido. Este ensaio discutiu a essencialidade destes serviços e propôs elementos para pautar esta decisão, tomando como base uma sucinta análise de benefícios e riscos sob a ótica individual e coletiva por meio de pesquisa exploratória. Os diversos efeitos positivos da atividade física sobre a saúde permitiriam pressupor a importância da reabertura de academias de ginástica, contudo há distinções entre benefícios e riscos a curto e longo prazos relacionados às doenças crônicas e ao COVID-19 que permitem afirmar que as atividades físicas em âmbito domiciliar são mais adequadas neste momento da pandemia. Assim, não é momento de reabertura de academias de ginástica no país, sobretudo, por não as considerarmos como atividades essenciais

In May 2020, by presidential decree, gym centers were included in the list of essential activities. Although many states and municipalities did not adopt the presidential decree, it provided pressures in favor of the reopening. In the present study, we discuss the essentiality of these services and propose elements to guide this decision, based on a succinct analysis of benefits and risks from an individual and collective perspective through exploratory methods. The evidence on the various positive effects of physical activity on health is robust, which would allow us to assume the importance of reopening fitness centers. However, there are distinctions between short and long term benefits and risks related to chronic diseases and COVID-19 that allow us to affirm that physical activities at home are more appropriate for this moment of the pandemic in which there is an increasing number of infected and deaths

Strength training with blood flow restriction - a novel therapeutic approach for older adults with sarcopenia? A case report.

INTRODUCTION: A 91-year-old sedentary man presenting exhaustion, lower-limb weakness, hypertension, and history of multiple falls was diagnosed with sarcopenia - appendicular skeletal muscle mass index (ASM) of 7.10 kg/m2. PURPOSE: To investigate the effects of strength training performed with low intensity in isolation (LI) or with blood flow restriction (LI-BFR) on strength, muscle mass, IGF-1, endothelial function, microcirculation, inflammatory biomarkers, and oxidative stress. METHODS: In the first 3 months, LI was performed with intensity corresponding to 30% of 1 repetition maximum, followed by 1 month of inactivity, and another 3 months of LI-BFR (similar load than LI concomitant to BFR equivalent to 50% of resting systolic blood pressure). RESULTS: LI-BFR, but not LI improved muscle mass, ASM, handgrip strength, isokinetic peak torque, IL-6, and IGF-1. Endothelial function, red blood cell velocity, and concentrations of C-reactive protein, and soluble intercellular adhesion molecules-1 improved after both LI and LI-BFR. Endothelin-1 and oxidative stress increased after LI-BFR, and lowered after LI. CONCLUSION: LI-BFR, but not LI improved strength, muscle mass, IGF-1, endothelial function, and selected inflammatory markers in a nonagenarian sarcopenic patient. These results are promising and suggest that LI-BFR should be considered as an alternative to prevent muscle loss and improve functional fitness in frail older populations.

Blood Flow Restriction Training Reduces Blood Pressure During Exercise Without Affecting Metaboreflex Activity.

Objective: Blood flow restriction training (BFRT) has been proposed to induce muscle hypertrophy, but its safety remains controversial as it may increase mean arterial pressure (MAP) due to muscle metaboreflex activation. However, BFR training also causes metabolite accumulation that may desensitize type III and IV nerve endings, which trigger muscle metaboreflex. Then, we hypothesized that a period of BFR training would result in blunted hemodynamic activation during muscle metaboreflex. Methods: 17 young healthy males aged 18-25 yrs enrolled in this study. Hemodynamic responses during muscle metaboreflex were assessed by means of postexercise muscle ischemia (PEMI) at baseline (T0) and after 1 month (T1) of dynamic BFRT. BFRT consisted of 3-min rhythmic handgrip exercise applied 3 days/week (30 contractions per minute at 30% of maximum voluntary contraction) in the dominant arm. On the first week, the occlusion was set at 75% of resting systolic blood pressure (always obtained after 3 min of resting) and increased 25% every week, until reaching 150% of resting systolic pressure at week four. Hemodynamic measurements were assessed by means of impedance cardiography. Results: BFRT reduced MAP during handgrip exercise (T1: 96.3 ± 8.3 mmHg vs. T0: 102.0 ± 9.53 mmHg, p = 0.012). However, no significant time effect was detected for MAP during the metaboreflex activation (P > 0.05). Additionally, none of the observed hemodynamic outcomes, including systemic vascular resistance (SVR), showed significant difference between T0 and T1 during the metaboreflex activation (P > 0.05). Conclusion: BFRT reduced blood pressure during handgrip exercise, thereby suggesting a potential hypotensive effect of this modality of training. However, MAP reduction during handgrip seemed not to be provoked by lowered metaboreflex activity.

Patients with heart failure in the "intermediate range" of peak oxygen uptake: additive value of heart rate recovery and the minute ventilation/carbon dioxide output slope in predicting mortality.

PURPOSE: While patients with heart failure who achieve a peak oxygen uptake (peak VO2) of 10 mL·kg(-1)·min(-1) or less are often considered for intensive surveillance or intervention, those achieving 14 mL·kg(-1)·min(-1) or more are generally considered to be at lower risk. Among patients in the "intermediate" range of 10.1 to 13.9 mL·kg(-1)·min(-1), optimally stratifying risk remains a challenge. METHODS: Patients with heart failure (N = 1167) referred for cardiopulmonary exercise testing were observed for 21 ± 13 months. Patients were classified into 3 groups of peak VO2 (≤10, 10.1-13.9, and ≥14 mL·kg(-1)·min(-1)). The ability of heart rate recovery at 1 minute (HRR1) and the minute ventilation/carbon dioxide output (VE/VCO2) slope to complement peak VO2 in predicting cardiovascular mortality were determined. RESULTS: Peak VO2, HRR1 (<16 beats per minute), and the VE/VCO2 slope (>34) were independent predictors of mortality (hazard ratio 1.6, 95% CI: 1.2-2.29, P = .006; hazard ratio 1.7, 95% CI: 1.1-2.5, P = .008; and hazard ratio 2.4, 95% CI: 1.6-3.4, P < .001, respectively). Compared with those achieving a peak VO2 ≥ 14 mL·kg(-1)·min(-1), patients within the intermediate range with either an abnormal VE/VCO2 slope or HRR1 had a nearly 2-fold higher risk of cardiac mortality. Those with both an abnormal HRR1 and VE/VCO2 slope had a higher mortality risk than those with a peak VO2 ≤ 10 mL·kg(-1)·min(-1). Survival was not different between those with a peak VO2 ≤ 10 mL·kg(-1)·min(-1) and those in the intermediate range with either an abnormal HRR1 or VE/VCO2 slope. CONCLUSIONS: HRR1 and the VE/VCO2 slope effectively stratify patients with peak VO2 within the intermediate range into distinct groups at high and low risk.

Long-term stability of the oxygen pulse curve during maximal exercise.

INTRODUCTION: Exercise oxygen pulse (O2 pulse), a surrogate for stroke volume and arteriovenous oxygen difference, has emerged as an important variable obtained during cardiopulmonary exercise testing. OBJECTIVES: We hypothesized that the O2 pulse curve pattern response to a maximal cycling ramp protocol exhibits a stable linear pattern in subjects reevaluated under the same clinical conditions. METHODS: We retrospectively studied 100 adults (80 males), mean age at baseline of 59 + 12 years, who performed two cardiopulmonary exercise testings (median interval was 15 months), for clinical and/or exercise prescription reasons. The relative O2 pulse was calculated by dividing its absolute value by body weight. Subjects were classified into quintiles of relative O2 pulse. Cardiopulmonary exercise testing results and the O2 pulse curve pattern, expressed by its slope and intercept, were compared among quintiles of relative O2 pulse at both cardiopulmonary exercise testings. RESULTS: After excluding the first minute of CPX (rest-exercise transition), the relative O2 pulse curve exhibited a linear increase, as demonstrated by high coefficients of determination (R² from 0.75 to 0.90; p < 0.05 for all quintiles). Even though maximum oxygen uptake and relative O2 pulse were significantly higher in the second cardiopulmonary exercise testing for each quintile of relative O2 pulse (p < 0.05 for all comparisons), no differences were found when slopes and intercepts were compared between the first and second cardiopulmonary exercise testings (p > 0.05 for all comparisons; except for intercept in the 5th quintile). CONCLUSION: Excluding the rest-exercise transition, the relative O2 pulse exhibited a stable linear increase throughout maximal exercise in adults that were retested under same clinical conditions.

Long-term stability of the oxygen pulse curve during maximal exercise

INTRODUCTION: Exercise oxygen pulse (O2 pulse), a surrogate for stroke volume and arteriovenous oxygen difference, has emerged as an important variable obtained during cardiopulmonary exercise testing. OBJECTIVES: We hypothesized that the O2 pulse curve pattern response to a maximal cycling ramp protocol exhibits a stable linear pattern in subjects reevaluated under the same clinical conditions. METHODS: We retrospectively studied 100 adults (80 males), mean age at baseline of 59 + 12 years, who performed two cardiopulmonary exercise testings (median interval was 15 months), for clinical and/or exercise prescription reasons. The relative O2 pulse was calculated by dividing its absolute value by body weight. Subjects were classified into quintiles of relative O2 pulse. Cardiopulmonary exercise testing results and the O2 pulse curve pattern, expressed by its slope and intercept, were compared among quintiles of relative O2 pulse at both cardiopulmonary exercise testings. RESULTS: After excluding the first minute of CPX (rest-exercise transition), the relative O2 pulse curve exhibited a linear increase, as demonstrated by high coefficients of determination (R² from 0.75 to 0.90; p<0.05 for all quintiles). Even though maximum oxygen uptake and relative O2 pulse were significantly higher in the second cardiopulmonary exercise testing for each quintile of relative O2 pulse (p<0.05 for all comparisons), no differences were found when slopes and intercepts were compared between the first and second cardiopulmonary exercise testings (p>0.05 for all comparisons; except for intercept in the 5th quintile). CONCLUSION: Excluding the rest-exercise transition, the relative O2 pulse exhibited a stable linear increase throughout maximal exercise in adults that were retested under same clinical conditions.

Influência da padronização respiratória na resposta da frequência cardíaca à transição repouso-exercício em coronariopatas de um programa de exercício supervisionado / Influence of respiratory standardization on heart rate response during rest-exercise transitions in coronary artery disease patients in a supervised exercise program

Fundamentos: Estudos anteriores demonstraram que a retirada vagal esforço-induzido não é influenciada pela padronização da respiração em indivíduos saudáveis, contudo é desconhecido se o mesmo comportamento ocorre em coronariopatas. Objetivo: Avaliar a influência da padronização respiratória sobre a retirada vagal esforço-induzida em um exercício súbito e dinâmico em coronariopatas participantes de um programa de exercício supervisionado. Métodos: Trinta coronariopatas participantes de um programa de exercício supervisionado (64+-10 anos de idade) realizaram, em ordem randomizada, dois protocolos de pedaladas em um cicloergômetro sem carga, a saber; a) quatro segundo de pedaladas sem padronização respiratória (SPR) e; b) pedalando 4º e 8º segundos de uma apnéia inspiratória máxima e 12s (CPR). separados por dois minutos de repouso. Traçados eletrocardiográficos digitais...

Influence of different respiratory maneuvers on exercise-induced cardiac vagal inhibition.

Physical exercise inhibits cardiac vagal activity. To study the relationship between heart rate (HR) and respiratory pattern, we applied the 4-s exercise test (4sET) and measured cardiac vagal index (CVI) in 30 healthy subjects who served as their own controls, using the standard plus three additional variations, essentially respiratory, of the original protocol: (a) a maximum inspiratory apnea of 16 s, of which 8 s were in the pre-exercise phase (4sET(insp)); (b) free respiratory pattern (4sET(unc)); and (c) maximum expiratory apnea of 12 s (4sET(exp)). The respective results were expressed by the following CVIs: CVI(insp), CVI(unc) and CVI(exp). CVI was determined in a continuous digital ECG recording through a specific ratio of two RR interval durations. The results [(mean +/- SEM)] for the four different maneuvers were as follows: CVI (1.56 +/- 0.05), CVI(insp) (1.55 +/- 0.05), CVI(unc) (1.63 +/- 0.05) and CVI(exp) (1.37 +/- 0.02). ANOVA-Bonferroni significant differences were only found between CVI(exp) and CVI(insp) (P = 0.009), CVI(unc) (P < 0.001) and CVI (P = 0.003). Dividing our sample in terciles according to CVI values, those with lower CVI, showed an attenuation of biphasic HR response after a 15 s maximum inspiratory apnea. We conclude that cardiac vagal reflex seems to be influencing the biphasic HR response modulation after a 12 s inspiratory apnea as described in the original protocol of 4sET, and this appears to be the option that best discriminates the cardiac vagal reflex, with less variability in the maneuvers when subjects are divided in terciles.

Dez anos de programa de exercício supervisionado: características dos pacientes e das intercorrências clínicas / 10 years supervised exercise program: characteristics of patients and clinical complications

Fundamentos: Há pouca informação no Brasil sobre as características e o perfil clínico dos pacientes que participam de um programa de exercício supervisionado (PES), assim como as intercorrências clínicas e eventuais óbitos relacionados ou não às sessões de PES. Objetivos: a) Analisar o perfil clínico e as principais características dos indivíduos que participaram de um PES no período de 10 anos; b) Quantificar o número de óbitos e intercorrências clínicas ocorridas nos pacientes do PES, em função do número de pacientes-hora. Métodos: Trata-se de um estudo retrospectivo, dividido em duas análises. A primeira baseada em dados obtidos entre 1994 e junho de 2004, e a segunda baseada em dados obtidos entre 2001 e junho de 2004. Todas as intercorrências clínicas ocorridas na chegada, durante e após o PES foram registradas em planilhas administradas pelos médicos responsáveis, bem como o número de pacientes-hora e óbitos no período. Resultados: Em 10 anos de follow-up, 1039 pacientes (647 homens), com média de idade de 58 maior ou menor que 15 (9 a 92) anos, participaram do PES, totalizando 111646 pacientes-hora. Observou-se uma crescente participação dos idosos. Foram registrados 45 óbitos, nenhum associado ao PES. Foram registrados 319 intercorrências clínicas (61,4 por cento - cardiovascular) em uma subsoma de 664 pacientes (427 homens), 44 por cento e 11,5 por cento de coronariopatas e saudáveis, respectivamente, totalizando 64690 pacientes-hora. Conclusões: a) ao longo de 10 anos de PES, o encaminhamento é cada vez mais freqüente e de indivíduos relativamente mais idosos e com casos clínicos mais complexos; b) as avaliações médicas na pré-admissão e pré-sessão do PES parecem contribuir para a inexistência de óbitos em 111646 pacientes-hora...

[Home exercise program: short term effects on physical aptitude and blood pressure in hypertensive individuals]. / Programa domiciliar de exercícios: efeitos de curto prazo sobre a aptidão física e pressão arterial de indivíduos hipertensos.

OBJECTIVE: To observe the influence of a four-month-unsupervised-exercise program performed at home on the blood pressure (BP) and physical performance in hypertensive adults. METHODS: A target group with 26 men and 52 women, and a control group with 9 men and 7 women were observed, with ages ranging from 25 to 77 years old. The target group underwent a home exercise program, basically with aerobic activity (60-80% of the estimated maximum heart rate for the age, 30 min of walking at least 3 times a week), in addition to the flexibility exercises. Guidelines on the control chart and variables that could influence the treatment were given at each assessment. Patients were followed-up for four months, with assessments every 2 months observing: BP at rest; body weight, waist-hip ratio (W/HR), body fat percentage (%F), sum of skinfold measurements (SM) and central-peripheral skinfold ratio (C/P); trunk flexibility (TF); heart rate and workload ratio during submaximal test in cycle ergometer (HR/W), represented by the regression curve inclination between both (a). RESULTS: The target group demonstrated significant alterations in weight (-3.7 kg), WHR (-0.03), SM (-12 mm), %F (-4.4%), TF (+2.3 cm), HR/W (-0.02) and BP (-6 and -9 mmHg for systolic and diastolic pressure respectively). The control group presented small weight alterations (+1.3 Kg) and %F (+1.7%). CONCLUSION: Unsupervised exercise home programs, even in short term, may present positive effects on the blood pressure and physical performance in hypertensive individuals.

Programa domiciliar de exercícios: efeitos de curto prazo sobre a aptidão física e pressão arterial de indivíduos hipertensos / Home exercise program: short term effects on physical aptitude and blood pressure in hypertensive individuals

OBJETIVO: Observar a influência de quatro meses de um programa domiciliar não-supervisionado de exercícios sobre a pressão arterial (PA) e aptidão física em hipertensos. MÉTODOS: Foram observados um grupo experimental com 26 homens e 52 mulheres e um grupo controle, com 9 homens e 7 mulheres, com idades entre 25 e 77 anos. O grupo experimental submeteu-se a um programa domiciliar de exercícios, com atividades aeróbias (60-80 por cento da FC máxima para a idade, 30min de caminhadas no mínimo três vezes por semana), exercícios de flexibilidade. Orientacões sobre a ficha de controle e o treinamento eram dadas a cada reavaliacão. Foram acompanhados por quatro meses, com reavaliacões a cada dois meses, observando-se: PA em repouso; peso corporal, relacão cintura-quadril (RCQ), percentual de gordura ( por centoG), somatório de dobras cutâneas (SOMD) e relacão central e periférica de dobras (P/C); flexibilidade de tronco (FX); relacão entre freqüência cardíaca e carga de trabalho durante teste submáximo em ciclo-ergômetro (FC/W), traduzida pela inclinacão da curva de regressão entre ambas (a). RESULTADOS: O grupo experimental exibiu alteracões significativas para o peso (-3,7 kg), RCQ (-0,03), SOMD (-12 mm), por centoG (-4,4 por cento), FX (+2,3 cm), FC/W (-0,02) e PA (-6 e -9 mmHg para pressão sistólica e diastólica, respectivamente). O grupo controle teve pequenas alteracões no peso (+1,3 Kg) e por centoG (+1,7 por cento). CONCLUSAO: Programas domiciliares não supervisionados de exercícios, podem exercer efeito positivo sobre a PA e aptidão física de hipertensos.