Nutritional Risk by Mini Nutritional Assessment (MNA), but Not Anthropometric Measurements, Has a Good Discriminatory Power for Identifying Frailty in Elderly People: Data from Brazilian Secondary Care Clinic.

OBJECTIVES: To investigate, in elderly individuals registered at a secondary outpatient clinic, the prevalence of frailty and pre-frailty and to identify the discriminatory power of anthropometric measurements and nutritional risk in identifying these conditions. DESIGN: Cross-sectional study with data extracted from medical records. SETTING AND PARTICIPANTS: Elderly patients (60+ years) from a geriatric outpatient clinic, located in the southeast area of São Paulo, Brazil. MEASUREMENTS: Frailty was assessed using five criteria proposed by Fried et al (2001), with some modifications. Nutritional risk was identified using Mini Nutritional Assessment (MNA). Body weight and body height were measured and used to calculate the body mass index (BMI). The discriminatory power of these parameters for the identification of frailty was determined by Receiver Operating Characteristics (ROC) curves. RESULTS: The final sample was composed of 254 patients, from which 31.1% were identified as frail and 53.5% as prefrail. The MNA indicated that 3.1% were malnourished and 35.4% were at risk of malnutrition. The BMI values 39.4% as overweight/obese and 19.9% as undernourished. As just the MNA revealed differences for frailty classification, only this parameter was investigated by ROC curve. The discriminatory power of the MNA for frailty presented a best cut-off point of ≤23.0 and the AUC was 0.812 (sensitivity=55.7; specificity=94.9), with a youden index of 0.5057 (95%CI= 0.3146-0.5946). MNA did not present sufficient discriminatory power to detect pre-frailty. CONCLUSION: The MNA was capable of indicating frailty, but not pre-frailty in this sample. BMI did not display significant predictive power for frailty or pre-frailty.

Self-initiated changes in physical activity levels improve cardiometabolic profiles: A longitudinal follow-up study.

BACKGROUND AND AIMS: While studies have described the importance of higher physical activity levels (PAL) in weight loss, the impact of self-initiated PAL on health status warrants further study. We aimed to prospectively examine the effects of self-initiated longitudinal PAL changes on body mass index (BMI) and cardiometabolic parameters in normal weight, overweight and obese adults. METHODS AND RESULTS: We included 4840 adults (mean age 41.6 ± 7.9 years, 79% male) undergoing routine health screening examinations. Self-reported PAL, height, weight, blood pressure and blood samples were collected at baseline and after a mean (95% confidence interval) follow up of 536 (531-541) days. Subjects were stratified according to BMI [39.8% normal weight (<25 kg/m2), 45.1% overweight (25.0-29.9 kg/m2), and 19.1% obese (≥30 kg/m2)]. In normal weight individuals, BMI increased from baseline to follow-up, irrespective of PAL changes. On the other hand, overweight and obese individuals that increased PAL experienced a decrease in BMI by -0.9% and -3.1%, respectively (p < 0.05). Overweight and obese individuals that increased PAL also experienced a decrease in -5.8% -4.6% in non-HDL concentrations from baseline to follow-up (p < 0.05). Finally, in overweight individuals, LDL cholesterol concentrations decreased from baseline to follow-up, irrespective of PAL changes whereas in obese individuals, a maintenance or increased PAL were associated with a decrease in -4.7% and -6.1% (p < 0.05), respectively. CONCLUSIONS: In a large cohort of screening patients, longitudinal self-initiated PAL is associated with improved BMI and cardiometabolic profile in overweight and obese individuals.

A Single Bout of Arm-crank Exercise Promotes Positive Emotions and Post-Exercise Hypotension in Patients with Symptomatic Peripheral Artery Disease.

OBJECTIVE/BACKGROUND: The objective was to analyze the acute effects of a single bout of arm cranking exercise on affective and cardiovascular parameters in patients with symptomatic peripheral artery disease (PAD). METHODS: This was a prospective, controlled, crossover study. Eleven men with symptomatic PAD underwent two experimental sessions in a random order: control or arm crank exercise (15 × 2 minutes bouts of arm crank exercise interrupted by 2 minutes rest intervals). During exercise, ratings of perceived exertion (Borg scale) and affective responses (pleasure/displeasure) were obtained at the first, fifth, tenth, and fifteenth bouts. Before and after the experimental sessions, cardiovascular parameters (blood pressure and heart rate) were obtained. Data were analysed by a two-way repeated measure analysis of variance with significance achieved at p < .05. RESULTS: During the arm crank exercise, patients reported positive feelings of pleasure. During exercise, heart rate (HR) remained within 80-90% of peak HR. Additionally, patients performed arm crank exercise with moderate levels of perceived exertion (Borg rating of 11-13) and with pleasant affective scores (Feeling Scale of +1 to +5). Blood pressure (systolic, diastolic, and mean) increase was lower after arm crank exercise than for control (greatest net effect: -15 ± 11 mmHg [p < .001]; -9 ± 5 mmHg [p < .001]; -9 ± 6 mmHg [p < .001], respectively), while HR increased (greatest net effect: +9 ± 6 beats per minute; p < .001). CONCLUSION: A single bout of arm crank exercise promotes pleasurable feelings while reducing blood pressure in patients with symptomatic PAD.

Factors Associated with Sedentary Behavior in Patients with Intermittent Claudication.

OBJECTIVES: Time spent in sedentary behavior has been associated with cardio-metabolic risk factors in the general population and in patients with symptomatic peripheral artery disease (PAD). Given the association of sedentary behavior and poor health outcomes, it is important to identify factors associated with sedentary behavior in these patients. The aim of this study was to identify factors associated with the sedentary time in patients with symptomatic PAD. METHODS: The sample included 297 patients with symptomatic PAD. Sedentary behavior was assessed using a step activity monitor and the patients were divided into tertiles. Demographic data, body mass index, comorbid conditions, and measures of severity of PAD (ankle brachial index, ischemic window, claudication measurements, peak oxygen uptake and walking economy) were obtained. RESULTS: Patients in the highest tertile (i.e. more sedentary) had a higher body mass index and a higher prevalence of diabetes mellitus, metabolic syndrome, and obesity than patients in the lowest tertile, whereas their peak walking time, peak oxygen uptake, and walking economy were lower (p < .05 for all). Using multiple regression procedures, the factors associated with the sedentary time were male sex (b = .217, R2 = .180, p = .001), body mass index (b = .154, R2 = .059, p = .013), peak walking time (b = -.360, R2 = .066, p ≤ .001), and walking economy (b = -.187, R2 = .142, p = .004). CONCLUSION: In patients with symptomatic PAD, greater time spent in sedentary behavior was found in men, and in patients with higher body mass index, lower peak walking time, and lower walking economy.

Inter- and Intra-Individual Analysis of Post-Exercise Hypotension Following a Single Bout of High-Intensity Interval Exercise and Continuous Exercise: A Pilot Study.

Recently, post-exercise blood pressure (BP) has been considered a predictive tool to identify individuals who are responsive or not to BP reductions with exercise training (i. e., "high" and "low responders"). This study aimed to analyze the inter- and intra-individual BP responsiveness following a single bout of high-intensity interval exercise (HIIE) and continuous exercise (CE) in normotensive men (n=14; 24.5±4.2 years). Mean change in BP during the 60 min period post-exercise was analyzed and minimal detectable change (MDC) was calculated to classify the subjects as "low" (no post-exercise hypotension [PEH]) and "high responders" (PEH occurrence) following each exercise protocol (inter-individual analysis). The MDC for systolic and diastolic BP was 5.8 and 7.0 mmHg. In addition, a difference equal/higher than MDC between the exercise protocols was used to define an occurrence of intra-individual variability in BP responsiveness. There were "low" and "high" PEH responders following both exercise protocols (inter-individual variability) as well as subjects who presented higher PEH following a specific exercise protocol (intra-individual variability between exercise protocols). These results were observed mainly for systolic BP. In summary, PEH is a heterogeneous physiological phenomenon and, for some subjects, seems to be exercise-protocol dependent. Further investigations are necessary to confirm our preliminary findings.

Walking Capacity Is Positively Related with Heart Rate Variability in Symptomatic Peripheral Artery Disease.

OBJECTIVES: The aim was to investigate the association between walking capacity and HRV in patients with symptomatic peripheral artery disease (PAD). METHODS: This was a cross sectional study. Ninety-five patients were recruited. Patients undertook a supine position for 20 minutes, with the final 10 minutes used to examine for resting HRV. Time domain, frequency domain, and non-linear indices were evaluated. A maximal treadmill test (Gardner protocol) was performed to assess maximal walking distance (MWD) and claudication distance (CD) in groups of PAD patients based upon their walking abilities (low, moderate, high). Differences between PAD patient groups were examined using non-parametric analyses, and Spearman rank correlations identified the relationship between MWD and CD, and HRV parameters. RESULTS: Symptomatic PAD patients with high MWD exhibited significantly greater HRV than patients with low MWD. Furthermore, MWD was positively associated with time domain and non-linear indices of HRV (all p < .05). However, no statistically significant correlations were observed between CD and HRV parameters or between PAD groups. CONCLUSION: A greater walking capacity is associated with better HRV in symptomatic PAD patients.

Vascular Mechanisms of Post-exercise Blood Pressure Responses in Peripheral Artery Disease.

This study aimed to analyze the vascular mechanisms involved in post-resistance decreases in blood pressure in patients with peripheral artery disease. 17 patients underwent 2 experimental sessions conducted in random order: resistance exercise (REx-3×10 reps in 8 exercises with intensity of ~ 60% of 1 RM) and control (C- resting on the exercise machines for 50 min). Before and after each experimental session, blood pressure, reflected wave indicators, pulse wave velocity, blood flow, blood flow post-reactive hyperemia and peripheral vascular resistance responses were obtained. Both sessions increased brachial systolic, diastolic and mean blood pressure (greatest increase REx: 11 mmHg; greatest increase C: 19 mmHg; P<0.01); however, the increases were greater after the C session (P<0.01). Reflected wave indicators increased only after the C session (P<0.06), while pulse wave velocity increased similarly after both sessions (P=0.66). Individual analyses indicated a large variability between patients in vascular variables responses. A single bout of REx decreased blood pressure in peripheral artery disease patients, and these responses were followed by changes in reflected wave indicators. The other factors presented high individual variability, and thus it was not possible to identify specific factors associated with blood pressure reduction in peripheral artery disease patients.

Correlation between acute and short-term changes in flexibility using two stretching techniques.

This study aimed to determine whether increases in flexibility following a single session predict increases in flexibility after a short-term stretching training program involving static stretching (SS) or proprioceptive neuromuscular facilitation (PNF) techniques. 70 adults (aged 18-30 years) of both sexes were randomly assigned to 2 groups: PNF (2 series of contract-relax stretching) and SS (static stretching for 1 min). Both stretching protocols were performed for 7 consecutive days. Active knee extension was evaluated before and after the first session and one day after the end of the intervention. Two-way ANOVA showed significant flexibility gains for both groups and no difference between them. The changes in flexibility after the first intervention session were strongly correlated with the changes after the training program in both groups (PNF r=0.82, p=0.001; SS: r=0.82, p=0.001). Linear regression showed that the increases in flexibility predicted the gains after both training programs (PNF: r(2)=0.67, p=0.001; SS: r(2)=0.61, p=0.005). In conclusion, the acute changes in flexibility after a single session of PNF and SS predict the gains in flexibility after longer-term training -programs.

Does exercise intensity affect blood pressure and heart rate in obese adolescents? A 6-month multidisciplinary randomized intervention study.

BACKGROUND: Aerobic exercise improves cardiovascular health in general, but whether the impact varies with exercise intensity is not clear. OBJECTIVE: The aim of the current study was to compare the effects of a high-intensity aerobic exercise training (HIT) vs. a low-intensity aerobic exercise training (LIT) on blood pressure (BP), heart rate (HR) and heart rate variability (HRV) in obese adolescents. METHODS: Forty-three (13-18 years) Tanner stage (III-IV) matched obese adolescents were studied in a randomized trial of either HIT (corresponding to the ventilatory threshold I; n = 20) or LIT (corresponding to 20% below the ventilatory threshold I; n = 23) programme for a period of 6 months. All participants also received a multidisciplinary therapy that included nutritional, psychological and clinical counselling. Both HIT and LIT sessions were isocaloric, with energy expenditure set at 350 kcal. BP, HR and HRV were measured along with markers of body adiposity and insulin resistance before and after the respective interventions. RESULTS: The participants in both groups had similar physical and clinical characteristics. After the 6-month intervention, systolic, diastolic and mean BP decreased (P < 0.05, for all) similarly in both groups, whereas waist circumference, HR and HRV showed beneficial changes only in the HIT group (P < 0.05). CONCLUSION: Aerobic exercise training set at a high intensity compared with the low intensity appears to have additional benefits on abdominal obesity and cardiovascular health in that it enhances the parasympathetic and autonomic modulation of the heart in obese adolescents.

Physical activity is inversely associated with high blood pressure independently of overweight in Brazilian adolescents.

The purpose of this study was to assess the relationship between blood pressure (BP) levels and physical activity (PA) domains accounting for overweight/obesity. Adolescents aged 10 to 17 years old were recruited (n = 1021). International Obesity Task Force (IOTF) criteria were used to define overweight and obesity. High BP was defined using the Center of Disease Control and Prevention criteria. Different domains of PA (school activities, sport out of school, and leisure time PA) were assessed using a validated questionnaire. The prevalence of overweight/obesity was 21.9% for boys and 14.8% for girls. Some 13.4% of boys and 10.2% of girls, respectively, had high blood pressure (HBP). A strong and positive association was found between overweight and HBP. After adjustment for body mass index (BMI), total PA was inversely associated with BP. When all PA domains were entered simultaneously in a regression model, and after adjustment for BMI, only sport out of school was significantly and inversely associated with systolic BP [ß: -0.82 (-1.50; -0.13)]. These findings open avenue for the early prevention of HBP by the prevention of obesity and promotion of PA.

Changes in skeletal muscle mass assessed by anthropometric equations after resistance training.

The aim of this study was to analyze the validity of anthropometric equations to identify changes in skeletal muscle mass (SMM) after resistance training (RT). Anthropometric and dual energy x-ray absorptiometry (DXA) measurements were obtained at baseline and after RT in 15 trained Caucasian college men. Participants performed RT over 8 weeks, consisting of 8-9 exercises of 4 sets with 12/10/8/6 maximal repetitions and 1-2 min interval between sets. The training loads were gradually increased according to gains in muscular strength. 4 anthropometric equations were used for estimation of SMM: EQ1 (SMM, g=height×[0.0553×corrected thigh girth2 + 0.0987×forearm girth2 + 0.0331×corrected calf girth2] - 2445), EQ2 (SMM, g=height×[0.031×medial thigh girth2 + 0.064×corrected calf girth2 + 0.089×corrected arm girth2] - 3006), EQ3 (SMM, kg=height×[0.00744×corrected arm girth2 + 0.00088×corrected thigh girth2 + 0.00441×corrected calf girth2] + 2.4×gender - 0.048×age + race + 7.8) and EQ4 (SMM, kg=0.244×weight + 7.8×height + 6.6×gender - 0.098×age + race - 3.3). EQ1 and EQ2 overestimated the SMM (41.3% and 19.9%, respectively; P<0.05) while EQ3 and EQ4 were similar (P>0.05) to DXA at baseline. Although all equations and DXA revealed a significant increase in SMM after RT, changes were overestimated by EQ1 and EQ2 (P<0.05), but not by EQ3 and EQ4 (P>0.05). In addition, changes in SMM over time between EQ4 and DXA were significantly correlated (r=0.62; P<0.01). Thus, changes in SMM that occur after RT can be detected by EQ4 in trained young men.