Effects of telerehabilitation on cardiac remodeling and hemodynamics parameters in hypertensive older adults: A randomized controlled trial.

OBJECTIVE: This study aimed to assess the effects of telerehabilitation with multimodal exercise on cardiac remodeling and blood pressure in hypertensive older adults. METHODS: Thirty-two hypertensive older adults (66.7 ± 5.33 years; 29.5 ± 4.22 Kg/m2; 24 female) were randomized into either a telerehabilitation or a control group. Echocardiographic parameters and blood pressure were assessed before and after the 16-week intervention. The exercise program was supervised, individualized, and offered 3×/week via videoconference. RESULTS: Blood pressure significantly decreased after telerehabilitation when compared to the control group, presenting a large effect size. The moderate effect size in relative and posterior wall thickness (g = 0.63; g = 0.61), shortening fraction (g = 0.54), and ejection fraction (g = 0.68). CONCLUSION: As a preliminary study, telerehabilitation is favorable to promote a moderate clinical improvement of some cardiac morphofunctional parameters and reduce blood pressure in hypertensive older adults.

Occupational risks and musculoskeletal complaints among industrial workers: a cross-sectional study.

Introduction: Work-related musculoskeletal disorders result from the overuse of the musculoskeletal system and insufficient time for the structures to recover. They are generally characterized by chronic pain, paresthesia, feeling of heaviness and fatigue, especially in the upper extremities, concomitantly or not, with an insidious onset. Objectives: To characterize musculoskeletal complaints and occupational risks in workers with work-related musculoskeletal disorders. Methods: A cross-sectional observational study of 60 participants in a Workers' Health Reference Center with clinical and imaging diagnosis of work-related musculoskeletal disorders. The instrument used contained 30 questions about individual factors, occupational risks, and musculoskeletal abnormalities. The results were analyzed descriptively, and the chi-square test was used to assess associations with a significance level at p < 0.05. Data analysis was performed using BioEstat 5®. Results: Most participants were men (66.7%) working in the industrial sector. The most common complaint was pain (100%) in the shoulders (43.8%) and lumbar spine (22%), and the most common abnormalities were tendinopathies and intervertebral disc disorders. The following risk factors were identified: 8-hour workday (80%); repetitive gestures (86.7%); twisting (58.3%); bending (61.7%); standing (66.7%); manual work (96.7%); and 10-30 kg of weight handled (35%). Conclusions: A large number of workers exposed to biomechanical and organizational risks report musculoskeletal pain. Employers should check working conditions and adjust them, investing in health promotion and protection actions to effectively reduce the occurrence of these disorders.

Introdução: Os distúrbios osteomusculares relacionados ao trabalho são decorrentes da utilização excessiva do sistema osteomuscular e da falta de tempo para recuperação dessas estruturas. Geralmente, são caracterizados por dor crônica, parestesia, sensação de peso e fadiga, sobretudo em membros superiores, concomitantes ou não, de aparecimento insidioso. Objetivos: Caracterizar as queixas osteomioarticulares e os riscos ocupacionais em trabalhadores portadores de distúrbios osteomusculares relacionados ao trabalho. Métodos: Estudo observacional com análise transversal, realizado com 60 participantes em um Centro de Referência em Saúde do Trabalhador, com diagnóstico clínico e de imagem dos distúrbios osteomusculares relacionados ao trabalho. O instrumento utilizado continha 30 questões sobre fatores individuais, riscos ocupacionais e alterações osteomusculares. Foram realizadas análises descritivas e, para avaliar as associações, foi utilizado o teste qui-quadrado, considerando nível de significância p < 0,05. As análises foram realizadas no programa BioEstat 5®. Resultados: A amostra foi majoritariamente masculina (66,7%) e do setor industrial. A queixa mais relatada foi a dor (100%) nos ombros (43,8%) e região lombar da coluna (22%), e as alterações mais encontradas foram tendinopatias e transtornos nos discos vertebrais. Alguns fatores de risco identificados foram: jornada de trabalho de 8 horas (80%); realizar gestos repetitivos (86,7%); torções (58,3%); deslocamentos (61,7%); adotar a posição bípede (ortostática) do corpo (66,7%); trabalho manual (96,7%); transporte de peso entre 10 e 30 kg (35%). Conclusões: Um grande número de trabalhadores expostos a riscos biomecânicos e organizacionais relata dores musculoesqueléticas. Cabe aos empresários verificar as condições de trabalho e ajustá-las, investindo em ações de promoção e proteção à saúde, para efetivamente reduzir a ocorrência desses distúrbios.

EMG breakpoints for detecting anaerobic threshold and respiratory compensation point in recovered COVID-19 patients.

INTRODUCTION: A huge number of COVID-19 patients should be referred to rehabilitation programmes. Individualizing the exercise intensity by metabolic response provide good physiological results. The aim of this study was to investigate the validity of EMG as a non-invasive determinant of the anaerobic threshold and respiratory compensation point, for more precise exercise intensity prescription. METHODS: An observational cross-sectional study with 66 recovered COVID-19 patients was carried out. The patients underwent a cardiopulmonary exercise test with simultaneous assessment of muscle electromyography in vastus lateralis. EMG breakpoints were analyzed during the ramp-up protocol. The first and second EMG breakpoints were used for anaerobic threshold and respiratory compensation point determination. RESULTS: EMG and gas exchange analysis presented strong correlation in anaerobic threshold (r = 0.97, p < 0.0001) and respiratory compensation point detection (r = 0.99, p < 0.0001) detection. Bland-Altman analysis demonstrated a bias = -4.7 W (SD = 6.2 W, limits of agreement = -16.9 to 7.6) for anaerobic threshold detection in EMG compared to gas exchange analysis. In respiratory compensation point detection, Bland-Altman analysis demonstrated a bias = -2.1 W (SD = 4.5 W, limits of agreement = -10.9 to 6.6) in EMG compared to gas exchange analysis. EMG demonstrated a small effect size compared to gas exchange analysis in oxygen uptake and power output at anaerobic threshold and respiratory compensation point detection. CONCLUSIONS: EMG analysis detects anaerobic threshold and respiratory compensation point without clinical significant difference than gas exchange analysis (gold standard method) in recovered COVID-19 patients.

Transcranial direct current stimulation as a strategy to manage COVID-19 pain and fatigue.

The novel coronavirus disease (COVID-19) has infected millions of people worldwide and generated many sequels in the survivors, such as muscular pain and fatigue. These symptoms have been treated through pharmacological approaches; however, infected people keep presenting physical limitations. Besides, the COVID-19 damage to the central nervous system has also been related to the presence of some physical impairment, so strategies that focus on diverse brain areas should be encouraged. Transcranial Direct Current Stimulation (tDCS) is a non-pharmacological tool that could be associated with pharmacological treatments to improve the central nervous system function and decrease the exacerbation of the immune system response. tDCS targeting pain and fatigue-related areas could provide an increase in neuroplasticity and enhancements in physical functions. Moreover, it can be used in infirmaries and clinical centers to treat COVID-19 patients.

Neuromuscular efficiency is impaired during exercise in COPD patients.

AIM: to analyze respiratory and peripheral neuromuscular efficiency during exercise in COPD. METHODS: COPD patients (VEF1 = 39.25 ± 13.1 %) were paired with healthy subjects. It was performed cardiopulmonary exercise test with simultaneously electromyography (EMG). Respiratory neuromuscular efficiency was determined by relationship between tidal volume and diaphragm EMG. Peripheral neuromuscular efficiency was determined by relationship between power output and vastus lateralis EMG. RESULTS: Healthy subjects presented higher respiratory neuromuscular efficiency at moderate, heavy and maximum exercise intensities compared to COPD (p < 0.05). Healthy subjects presented higher peripheral neuromuscular efficiency at light, moderate, heavy and maximum exercise intensities compared to COPD (p < 0.001). Dynamic hyperinflation presented correlation with respiratory and peripheral neuromuscular efficiency (r = -0.73 and r = -0.76, p < 0.001). CONCLUSION: COPD patients have lower respiratory neuromuscular efficiency at moderate exercise intensity and lower peripheral neuromuscular efficiency at light exercise intensity. Dynamic hyperinflation affects respiratory and peripheral neuromuscular efficiency.

Short-Term Resistance Training Improves Cardiac Autonomic Modulation and Blood Pressure in Hypertensive Older Women: A Randomized Controlled Trial.

Oliveira-Dantas, FF, Brasileiro-Santos, MdS, Thomas, SG, Silva, AS, Silva, DC, Browne, RAV, Farias-Junior, LF, Costa, EC, and Santos, AdC. Short-term resistance training improves cardiac autonomic modulation and blood pressure in hypertensive older women: a randomized controlled trial. J Strength Cond Res 34(1): 37-45, 2020-This randomized controlled trial investigated the efficacy of short-term resistance training (RT) on cardiac autonomic modulation and peripheral hemodynamic parameters in hypertensive older women. Twenty-five hypertensive older women who were insufficiently active (64.7 ± 4.7 years) participated in this study. Subjects were randomly allocated to a 10-week RT program (2 d·wk in the first 5 weeks; 3 d·wk in the last 5 weeks) or a nonexercise control group. Linear reverse periodization was used for the RT program. Cardiac autonomic modulation, mean blood pressure (MBP), peripheral vascular resistance (PVR), and resting heart rate (RHR) were measured before and after 10 weeks. The RT group reduced cardiac sympathetic modulation (0V%; B = -6.6; 95% confidence interval [CI]: -12.9 to -0.2; p = 0.045; Cohen's d = 0.88) and showed a trend for increased parasympathetic modulation (2V%; B = 12.5; 95% CI: 0-25; p = 0.050; Cohen's d = 0.87) compared with the control group. The RT group reduced MBP (B = -8.5 mm Hg; 95% CI: -13.6 to -3.4; p = 0.001; Cohen's d = 1.27), PVR (B = -14.1 units; 95% CI: -19.9 to -8.4; p < 0.001; Cohen's d = 1.86), and RHR (B = -8.8 b·min; 95% CI: -14.3 to -3.3; p = 0.002; Cohen's d = 1.20) compared with the control group. In the RT group, the changes in 2V% patterns and low-frequency components showed a correlation with changes in MBP (r = -0.60; p = 0.032) and RHR (r = 0.75; p = 0.0003). In conclusion, 10 weeks of RT improved cardiac autonomic modulation and reduced MBP and PVR in hypertensive older women. These results reinforce the importance of RT for this population.

COVID-19 and social isolation: the consequences of not exercising for older adults' health

Abstract COVID-19 pandemic has required social isolation to prevent the virus from spreading. Initially, the elderly were the most affected by the novel coronavirus. However, the virus spread out worldwide, affecting all age groups. The elderly are commonly affected by several chronic diseases, and as a consequence of social isolation caused by the COVID-19 pandemic, the community-based exercise programs, which usually provide health and well-being to the elderly, have stopped their activities to avoid the virus to spread out; so, the elderly kept taking medicines but stopped exercising, which must impair their health and increase demand from the public health system. In this sense, the physical education professional is essential to providing safe approaches to the elderly who are not able to enroll in community-based exercise programs but need to exercise to improve their health. This article aims to discuss the consequences of not exercising in older adults' health during the social isolation caused by the COVID-19 pandemic; still, we intend to present adjunct strategies to allow the elderly to exercise even socially isolated.

Influence of obesity in pulmonary function and exercise tolerance in obese women with obstructive sleep apnea.

OBJECTIVE: To evaluate the influence of obesity on pulmonary function and exercise tolerance in women with obstructive sleep apnea (OSA). SUBJECTS AND METHODS: A descriptive analytic cross- sectional study was carried out. Thirty-nine (39) sedentary climacteric women, aged 45 to 60 years, were evaluated and submitted to polysomnography. The participants were divided into 4 groups: a) 'eutrophic non-OSA' (n = 13); b) 'eutrophic OSA' (n = 5); c) 'obese non-OSA' (n = 6); d) 'obese OSA' (n = 15). All subjects underwent clinical and anthropometric evaluation, followed by pulmonary function tests and 6-minute walk test (6MWT). RESULTS: There was a significant difference in the predicted percentage values of FEV1/FVC when comparing 'eutrophic OSA' and 'obese OSA' (97.6% ± 6.1% vs. 105.7% ± 5.7%, respectively; p = 0.025). The other spirometric variables did not show any differences between the studied groups. There was no significant difference in the maximum distance walked when the 'eutrophic non-OSA', 'eutrophic OSA', 'obese non-OSA' and 'obese OSA' groups were compared. CONCLUSION: Considering the results of this study, OSA itself did not influence pulmonary function or functional capacity parameters compared to eutrophic women. However, not only isolated obesity but also obesity associated with OSA can negatively impact sleep quality and lung function.

Influence of obesity in pulmonary function and exercise tolerance in obese women with obstructive sleep apnea

ABSTRACT Objective: To evaluate the influence of obesity on pulmonary function and exercise tolerance in women with obstructive sleep apnea (OSA). Subjects and methods: A descriptive analytic cross- sectional study was carried out. Thirty-nine (39) sedentary climacteric women, aged 45 to 60 years, were evaluated and submitted to polysomnography. The participants were divided into 4 groups: a) 'eutrophic non-OSA' (n = 13); b) 'eutrophic OSA' (n = 5); c) 'obese non-OSA' (n = 6); d) 'obese OSA' (n = 15). All subjects underwent clinical and anthropometric evaluation, followed by pulmonary function tests and 6-minute walk test (6MWT). Results: There was a significant difference in the predicted percentage values of FEV1/FVC when comparing 'eutrophic OSA' and 'obese OSA' (97.6% ± 6.1% vs. 105.7% ± 5.7%, respectively; p = 0.025). The other spirometric variables did not show any differences between the studied groups. There was no significant difference in the maximum distance walked when the 'eutrophic non-OSA', 'eutrophic OSA', 'obese non-OSA' and 'obese OSA' groups were compared. Conclusion: Considering the results of this study, OSA itself did not influence pulmonary function or functional capacity parameters compared to eutrophic women. However, not only isolated obesity but also obesity associated with OSA can negatively impact sleep quality and lung function.

Regular physical exercise improves cardiac autonomic and muscle vasodilatory responses to isometric exercise in healthy elderly.

The objective of this study was to evaluate cardiac autonomic control and muscle vasodilation response during isometric exercise in sedentary and physically active older adults. Twenty healthy participants, 10 sedentary and 10 physically active older adults, were evaluated and paired by gender, age, and body mass index. Sympathetic and parasympathetic cardiac activity (spectral and symbolic heart rate analysis) and muscle blood flow (venous occlusion plethysmography) were measured for 10 minutes at rest (baseline) and during 3 minutes of isometric handgrip exercise at 30% of the maximum voluntary contraction (sympathetic excitatory maneuver). Variables were analyzed at baseline and during 3 minutes of isometric exercise. Cardiac autonomic parameters were analyzed by Wilcoxon and Mann-Whitney tests. Muscle vasodilatory response was analyzed by repeated-measures analysis of variance followed by Tukey's post hoc test. Sedentary older adults had higher cardiac sympathetic activity compared to physically active older adult subjects at baseline (63.13±3.31 vs 50.45±3.55 nu, P=0.02). The variance (heart rate variability index) was increased in active older adults (1,438.64±448.90 vs 1,402.92±385.14 ms, P=0.02), and cardiac sympathetic activity (symbolic analysis) was increased in sedentary older adults (5,660.91±1,626.72 vs 4,381.35±1,852.87, P=0.03) during isometric handgrip exercise. Sedentary older adults showed higher cardiac sympathetic activity (spectral analysis) (71.29±4.40 vs 58.30±3.50 nu, P=0.03) and lower parasympathetic modulation (28.79±4.37 vs 41.77±3.47 nu, P=0.03) compared to physically active older adult subjects during isometric handgrip exercise. Regarding muscle vasodilation response, there was an increase in the skeletal muscle blood flow in the second (4.1±0.5 vs 3.7±0.4 mL/min per 100 mL, P=0.01) and third minute (4.4±0.4 vs 3.9±0.3 mL/min per 100 mL, P=0.03) of handgrip exercise in active older adults. The results indicate that regular physical activity improves neurovascular control of muscle blood flow and cardiac autonomic response during isometric handgrip exercise in healthy older adult subjects.

Neural mechanismsand post-exercise hypotension: the importance of experimental studies

Abstract A single bout of exercise can decrease blood pressure level in hypertensive individuals and this phenomenon is known as post-exercise hypotension (PEH). PEH is clinically important and reduces blood pressure after physical exercise in hypertensive subjects. This reduction has been attributed to autonomic mechanisms, e.g., reduced peripheral sympathetic activity, adjustments in cardiac autonomic balance and baroreflex sensitivity. Besides, evidence has suggested that the central baroreflex pathway has an important role in the occurrence of PEH. Therefore, the aim of this study was to review the effects of physical exercise on areas of the central nervous system involved in the regulation of blood pressure.(AU)

Effect of Strength Training on Oxidative Stress and the Correlation of the Same with Forearm Vasodilatation and Blood Pressure of Hypertensive Elderly Women: A Randomized Clinical Trial.

UNLABELLED: The aim of the study was to evaluate the effect of strength training on oxidative stress and the correlation of the same with forearm vasodilatation and mean blood pressure of hypertensive elderly women, at rest (basal) and during a static handgrip exercise. Insufficiently active hypertensive elderly women (N = 25; mean age = 66.1 years) were randomized into a 10 week strength training group (n = 13) or control (n = 12) group. Plasma malondialdehyde (MDA), total antioxidant capacity (TAC), plasma nitrite (NO2-), forearm blood flow (FBF), mean blood pressure (MBP) and vascular conductance ([FBF / MBP] x 100) were evaluated before and after the completion of the interventions. The strength training group increased the TAC (pre: Median = 39.0; Interquartile range = 34.0-41.5% vs post: Median = 44.0; Interquartile range = 38.0-51.5%; p = 0.006) and reduced the MDA (pre: 4.94 ± 1.10 µM vs post: 3.90 ± 1.35 µM; p = 0.025; CI-95%: -1.92 --0.16 µM). The strength training group increased basal vascular conductance (VC) (pre: 3.56 ±0.88 units vs post: 5.21 ±1.28 units; p = 0.001; CI-95%: 0.93-2.38 units) and decreased basal MBP (pre: 93.1 ±6.3 mmHg vs post: 88.9 ±5.4 mmHg; p = 0.035; CI-95%: -8.0 --0.4 mmHg). Such changes were also observed during static handgrip exercise. A moderate correlation was observed between changes in basal VC and MBP with changes in NO2- (ΔVC → r = -0.56, p = 0.047; ΔMBP → r = -0.41, p = 0.168) and MDA (ΔVC → r = 0.64, p = 0.019; ΔMBP → r = 0.31, p = 0.305). The strength training program reduced the oxidative stress of the hypertensive elderly women and this reduction was moderately correlated with their cardiovascular benefits. TRIAL REGISTRATION: ensaiosclinicos.gov.br RBR-48c29w.

Cardiac autonomic modulation in healthy elderly after different intensities of dynamic exercise.

PURPOSE: To investigate the heart rate (HR) and its autonomic modulation at baseline and during dynamic postexercise (P(EX)) with intensities of 40% and 60% of the maximum HR in healthy elderly. METHODS: This cross-sectional study included ten apparently healthy people who had been submitted to a protocol on a cycle ergometer for 35 minutes. Autonomic modulation was evaluated by spectral analysis of HR variability (HRV). RESULTS: A relevant increase in HR response was observed at 15 minutes postexercise with intensities of 60% and 40% of the maximum HR (10±2 bpm versus 5±1 bpm, respectively; P=0.005), and a significant reduction in HRV was also noted with 40% and 60% intensities during the rest period, and significant reduction in HRV (RR variance) was also observed in 40% and 60% intensities when compared to the baseline, as well as between the post-exercise intensities (1032±32 ms versus 905±5 ms) (P<0.001). In the HRV spectral analysis, a significant increase in the low frequency component HRV and autonomic balance at 40% of the maximum HR (68±2 normalized units [nu] versus 55±1 nu and 2.0±0.1 versus 1.2±0.1; P<0.001) and at 60% of the maximum HR (77±1 nu versus 55±1 nu and 3.2±0.1 versus 1.2±0.1 [P<0.001]) in relation to baseline was observed. A significant reduction of high frequency component at 40% and 60% intensities, however, was observed when compared to baseline (31±2 nu and 23±1 nu versus 45±1 nu, respectively; P<0.001). Moreover, significant differences were observed for the low frequency and high frequency components, as well as for the sympathovagal balance between participants who reached 40% and 60% of the maximum HR. CONCLUSION: There was an increase in the HR, sympathetic modulation, and sympathovagal balance, as well as a reduction in vagal modulation in the elderly at both intensities of the PEX.

Resistance exercise with different volumes: blood pressure response and forearm blood flow in the hypertensive elderly.

BACKGROUND: The purpose of this study was to evaluate the effect of two sessions of resistance exercise with different volumes on post-exercise hypotension, forearm blood flow, and forearm vascular resistance in hypertensive elderly subjects. METHODS: The study was conducted with ten hypertensive elderly (65±3 years, 28.7±3 kg/m(2)) subjected to three experimental sessions, ie, a control session, exercise with a set (S1), and exercise with three sets (S3). For each session, the subjects were evaluated before and after intervention. In the pre-intervention period, blood pressure, forearm blood flow, and forearm vascular resistance were measured after 10 minutes of rest in the supine position. Thereafter, the subjects were taken to the gym to perform their exercise sessions or remained at rest during the same time period. Both S1 and S3 comprised a set of ten repetitions of ten exercises, with an interval of 90 seconds between exercises. Subsequently, the measurements were again performed at 10, 30, 50, 70, and 90 minutes of recovery (post-intervention) in the supine position. RESULTS: Post-exercise hypotension was greater in S3 than in S1 (systolic blood pressure, -26.5±4.2 mmHg versus -17.9±4.7 mmHg; diastolic blood pressure, -13.8±4.9 mmHg versus -7.7±5 mmHg, P<0.05). Similarly, forearm blood flow and forearm vascular resistance changed significantly in both sessions with an increase and decrease, respectively, that was more evident in S3 than in S1 (P<0.05). CONCLUSION: Resistance exercises with higher volume were more effective in causing post-exercise hypotension, being accompanied by an increase in forearm blood flow and a reduction of forearm vascular resistance.

Chia flour supplementation reduces blood pressure in hypertensive subjects.

The aim of this study was to investigate the effect of chia supplementation (Salvia hispanica L.) on blood pressure (BP) and its associated cardiometabolic factors in treated and untreated hypertensive individuals. The subjects were randomly assigned to one of the following groups: the hypertensive-drug treated (CHIA-MD, n = 10), hypertensive untreated (CHIA-NM, n = 9) and placebo (PLA-MD, n = 7) groups. The subjects consumed 35 g/day of either chia flour or a placebo for 12 weeks. The clinical and ambulatory BP, inflammation, oxidative stress and markers for nitric oxide were measured. While the PLA-MD group showed no changes in BP, there was a reduction in the mean clinical blood pressure (MBP) in the CHIA (111.5 ± 1.9 to 102.7 ± 1.5 mmHg, p < 0.001) and CHIA-MD (111.3 ± 2.2 to 100.1 ± 1.8 mmHg, p < 0.001) groups. The CHIA-NM group showed no reduction in the MBP but did show a decreased systolic BP (146.8 ± 3.8 to 137.3 ± 3.1 mmHg, p < 0.05). The clinical BP reduction was demonstrated by a 24 h ambulatory systolic reduction in all of the supplemented groups. However, the mean ambulatory BP was reduced only in the CHIA (98.1 ± 2.4 to 92.8 ± 2.2 mmHg, p < 0.05) group, and there was no change in the diastolic component in either of the CHIA groups. The lipid peroxidation was reduced in the CHIA (p = 0.04) and CHIA-NM (p = 0.02) groups compared with the PLA-MD group. A reduction in the plasma nitrite levels was observed only in the CHIA group (p = 0.02). Chia flour has the ability to reduce ambulatory and clinical BP in both treated and untreated hypertensive individuals.

An equation for the prediction of oxygen consumption in a Brazilian population.

BACKGROUND: The equations predicting maximal oxygen uptake (VO2max or peak) presently in use in cardiopulmonary exercise testing (CPET) softwares in Brazil have not been adequately validated. These equations are very important for the diagnostic capacity of this method. OBJECTIVE: Build and validate a Brazilian Equation (BE) for prediction of VO2peak in comparison to the equation cited by Jones (JE) and the Wasserman algorithm (WA). METHODS: Treadmill evaluation was performed on 3119 individuals with CPET (breath by breath). The construction group (CG) of the equation consisted of 2495 healthy participants. The other 624 individuals were allocated to the external validation group (EVG). At the BE (derived from a multivariate regression model), age, gender, body mass index (BMI) and physical activity level were considered. The same equation was also tested in the EVG. Dispersion graphs and Bland-Altman analyses were built. RESULTS: In the CG, the mean age was 42.6 years, 51.5% were male, the average BMI was 27.2, and the physical activity distribution level was: 51.3% sedentary, 44.4% active and 4.3% athletes. An optimal correlation between the BE and the CPET measured VO2peak was observed (0.807). On the other hand, difference came up between the average VO2peak expected by the JE and WA and the CPET measured VO2peak, as well as the one gotten from the BE (p = 0.001). CONCLUSION: BE presents VO2peak values close to those directly measured by CPET, while Jones and Wasserman differ significantly from the real VO2peak.

An Equation for the Prediction of Oxygen Consumption in a Brazilian Population / Equação de Predição do Consumo de Oxigênio em uma População Brasileira

Background: The equations predicting maximal oxygen uptake (VO2max or peak) presently in use in cardiopulmonary exercise testing (CPET) softwares in Brazil have not been adequately validated. These equations are very important for the diagnostic capacity of this method. Objective: Build and validate a Brazilian Equation (BE) for prediction of VO2peak in comparison to the equation cited by Jones (JE) and the Wasserman algorithm (WA). Methods: Treadmill evaluation was performed on 3119 individuals with CPET (breath by breath). The construction group (CG) of the equation consisted of 2495 healthy participants. The other 624 individuals were allocated to the external validation group (EVG). At the BE (derived from a multivariate regression model), age, gender, body mass index (BMI) and physical activity level were considered. The same equation was also tested in the EVG. Dispersion graphs and Bland-Altman analyses were built. Results: In the CG, the mean age was 42.6 years, 51.5% were male, the average BMI was 27.2, and the physical activity distribution level was: 51.3% sedentary, 44.4% active and 4.3% athletes. An optimal correlation between the BE and the CPET measured VO2peak was observed (0.807). On the other hand, difference came up between the average VO2peak expected by the JE and WA and the CPET measured VO2peak, as well as the one gotten from the BE (p = 0.001). Conclusion: BE presents VO2peak values close to those directly measured by CPET, while Jones and Wasserman differ significantly from the real VO2peak. .

Fundamento: As equações que predizem o consumo máximo de oxigênio (leia-se VO2máx ou pico) utilizadas em softwares de teste cardiopulmonar de exercício (TCPE) no Brasil não foram validadas e têm importância fundamental no algoritmo diagnóstico desse exame. Objetivo: Construir e validar uma equação derivada de população brasileira (EB) para predição do VO2, comparando-a com a equação citada por Jones (EJ) e com o algoritmo de Wasserman (AW). Métodos: Foram avaliados, pelo TCPE, 3.119 indivíduos aparentemente saudáveis. Destes, 2.495 pertenceram ao grupo de construção (GC) e 624 foram alocados de forma aleatória no grupo de validação (GV). Na EB consideraram-se idade, gênero, índice de massa corporal (IMC) e nível de atividade física, sendo a mesma posteriormente testada no GV. Resultados: No GC, a idade média foi de 42,6 anos, 51,5% eram homens, o IMC médio foi de 27,2, sendo 51,3% sedentários, 44,4% ativos e 4,3% atletas. No GV não houve diferença entre o VO2pico médio medido pelo TCPE (29,92 mL.kg−1.min−1) e pela EB (29,80 mL.kg1.min−1/p = 0,571), sendo observada ótima correlação (0,898). O AW e a EJ tiveram valores médios diferentes do VO2pico medido (p <0,001). O percentual do erro total foi de 18%, 26% e 41% para EB, AW e EJ, respectivamente. A distribuição dos resíduos foi predominantemente negativa no AW (70,67%) e na EJ (87,66%), evidenciando que ambas superestimam os valores médios do VO2pico. Conclusão: A EB apresenta valores de VO2pico muito próximos do valor medido através do TCPE, enquanto o AW e a EJ diferem significativamente do VO2pico real. .

Qualidade do sono e tolerância ao esforço em portadores de apneia obstrutiva do sono / Sleep quality and stress tolerance in patients with obstructive sleep apnea / Calidad del sueño y la tolerancia al estrés en pacientes con apnea obstructiva del sueño

INTRODUÇÃO: O sono é um estado natural e recorrente, no qual acontecem processos neurobiológicos importantes. A má qualidade do sono está diretamente associada com piores indicadores de saúde. A qualidade do sono pode ser medida objetiva e subjetivamente por métodos como a polissonografia, que é o padrão de referência, ou por meio de testes e questionários, como o índice de qualidade de sono de Pittsburgh (IQSP). OBJETIVO: Correlacionar a qualidade do sono com a tolerância ao esforço em pacientes portadores da síndrome da apneia/hipopneia obstrutiva do sono (SAHOS). MÉTODOS: Participaram do estudo 63 indivíduos (57 mulheres e seis homens), média de idade de 51,7 ± 6,6 anos; índice de massa corpórea (IMC) média de 28,2 ± 5,0 kg/m2); índice de apneia/hipopneia (IAH) médio de 7,3 ± 10,50 eventos/hora, verificado através da polissonografia. Para a avaliação da qualidade do sono, os participantes responderam ao IQSP, e para a avaliação da tolerância ao esforço, realizaram o teste de caminhada de 6 minutos (TC6M). RESULTADOS: Não houve correlação entre o IQSP e o TC6M (Rs = -0,103620, p = 0,419), assim como entre o IAH e o TC6M (Rs = -0, 000984, p = 0,9939). Podemos sugerir que a qualidade do sono e a gravidade da SAHOS não afetam a tolerância ao esforço dos indivíduos com SAHOS. CONCLUSÃO: Estudos com uma amostra maior, levando-se em consideração a estratificação pela gravidade da SAHOS e utilizando métodos mais acurados de avaliação da capacidade funcional, devem ser realizados, a fim de que resultados mais abrangentes possam ser obtidos. .

INTRODUCTION: Sleep is a natural and recurring state, in which important neurobiological processes take place. Poor quality of sleep is directly associated with worse health indicators. Sleep quality can be measured objectively and subjectively by methods such as polysomnography, which is the gold standard, or tests and questionnaires as the Sleep Quality Index in Pittsburgh (PSQI). OBJECTIVE: To correlate the quality of sleep with exercise tolerance in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). METHODS: The study included 63 subjects (57 women and 6 men) aged 51.7 ± 6.6 years, with body mass index (BMI) 28.2 ± 5.0 kg/m2,apnea/hypopnea index (AHI) 7.3±10:50 events/hour, assessed by polysomnography. To assess the quality of sleep, participants responded the PSQI instrument and were submitted to the exercise tolerance test through the 6-minute walk test (6MWT). RESULTS: There was no correlation between the PSQI and the 6MWT (Rs = -0.103620, p = 0.419), and between the 6MWT and the AHI (R = -0, 000984, p = 0.9939). According to the results of this work, we suggest that the quality of sleep and the severity of OSAHS did not affect the exercise tolerance of individuals with OSAHS. CONCLUSION: Studies with a larger sample, taking into account the stratification by severity of OSAHS and using more accurate methods of functional capacity evaluation should be conducted, so that more comprehensive results can be obtained. .

INTRODUCCIÓN: El sueño es un estado natural y recurrente durante el cual acontecen procesos neurobiológicos importantes. La mala calidad del sueño está asociada directamente con peores indicadores de salud. La calidad del sueño puede ser medida objetiva y subjetivamente mediante métodos como la polisomnografía,, que es el estándar de referencia, o pruebas y cuestionarios como el índice de calidad de sueño de Pittsburgh (ICSP), OBJETIVO: Correlacionar la calidad del sueño con la tolerancia al esfuerzo en pacientes portadores del síndrome de la apnea/hipopnea obstructiva del sueño (SAHOS). MÉTODOS: Participaron en el estudio 63 individuos (57 mujeres y seis hombres), edad promedio de 51,7 ± 6,6 años; índice de masa corpórea (IMC) 28,2 ± 5,0 kg/m2); índice de apnea/hipopnea (IAH) 7,3 ± 10,50 eventos/hora, verificado por medio de la polisomnografía. Para la evaluación de la calidad del sueño, los participantes respondieron al ICSP y para la evaluación de la tolerancia al esfuerzo, realizaron la prueba de caminata de 6 minutos (PC6M). RESULTADOS: No hubo correlación entre el ICSP y la PC6M (Rs = -0,103620, p = 0,419), ni entre el IAH y la PC6M (Rs = -0, 000984, p = 0,9939). Podemos sugerir que la calidad del sueño y la gravedad del SAHOS no afectan a la tolerancia al esfuerzo de los individuos con SAHOS. CONCLUSIÓN: Se deben realizar los estudios con una muestra mayor, teniéndose en consideración la estratificación según la gravedad del SAHOS y utilizándose métodos más precisos para evaluación de la capacidad funcional, a fin de que se puedan obtener resultados de más alcance. .

Respostas hemodinâmicas durante exercício resistido com intensidades moderadas em idosas hipertensas / Hemodynamic responses during resistance exercise with moderate intensities in elderly hypertensive patients

O objetivo desse estudo foi avaliar a resposta da frequência cardíaca (FC), pressão arterial e sua modulação autonômica durante no exercício resistido com diferentes intensidades em idosos hipertensos. Doze idosas hipertensas e oito idosas normotensas foram submetidas à uma sessão de exercício resistido na cadeira extensora à 40% (EX40%) e 60% (EX60%) de uma repetição máxima (1RM). FC, PA e a variabilidade da frequência cardíaca foram obtidas antes, durante e após as sessões de exercício. Diante disso, observou-se que os protocolos de EX40% e EX60% promoveram um aumento significativo da FC em ambos os grupos, e este comportamento foi acompanhado pelo aumento significativo no componente de baixa frequência (BF) no balanço autonômico (BF/AF) e na redução da alta frequência (AF) em relação à condição basal, para ambos os grupos. No período de recuperação, os componentes de BF, AF e BF/AF retornaram aos valores basais em ambos os grupos no protocolo EX40%. Em EX60%, BF, AF e BF/AF foram restaurados a valores próximos dos basais para os hipertensos. Além disso, observou-se uma redução da Pressão arterial sistólica de 20mmHg para o grupo de normotensos e hipertensos no protocolo EX40%. Ainda para a Pressão arterial sistólica, na intensidade EX60%, o grupo normotenso e hipertenso apresentou uma redução 20 e 21 mmHg, respectivamente. Conclui-se que o exercício resistido com intensidades moderadas não promove exacerbação da modulação autonômica cardíaca em idosos hipertensos durante sua execução, visto que sua resposta foi similar a aquela observada em normotensos.

The aim of this study was to evaluate the response of heart rate (HR), blood pressure (BP) and its autonomic modulation during the resistance exercise with different intensities in elderly hypertensive patients. Twelve elderly hypertensive and eight normotensive elderly underwent a session of resistance exercise (RE) in knee extension at 40% (EX40%) and 60% (EX60%) of one repetition maximum (1RM). HR, BP and heart rate variability were obtained before, during and after exercise sessions. Thus, it was observed that the protocols EX40% and EX60% promoted a significant increase in HR in both groups, and this behavior was accompanied by a significant increase in the low frequency component (LF) in autonomic balance (LF / HF) and reducing the high frequency (HF) in relation to baseline values for both groups. During the recovery period, the components of LF, HF and LF/HF returned to baseline in both groups in the protocol EX40%. In EX60%, LF, HF and LF/HF were restored to values close to baseline for hypertensive patients. Furthermore, we observed a reduction in Systolic Blood Pressure of 20mmHg for the group of normotensive and hypertensive patients in the protocol EX40%. Even for systolic blood pressure, intensity EX60%, hypertensive and normotensive group showed a reduction 20:21 mmHg, respectively. We conclude that resistance exercise with moderate intensity exercise does not promote exacerbation of cardiac autonomic modulation in elderly hypertensive patients during their execution, as their response was similar to that observed in normotensive.

Obesidade e testes de função pulmonar em crianças e adolescentes: uma revisão sistemática / Obesity and pulmonary function tests in children and adolescents: a systematic review / Obesidad y pruebas de función pulmonar en niños: una revisión sistemática

OBJETIVO: Realizar uma revisão sistemática sobre os estudos observacionais que analisaram a relação entre os parâmetros espirométricos e a obesidade em crianças e adolescentes. FONTES DE DADOS: Os dados foram selecionados sem restrição de idioma, utilizando-se as bases de dados PubMed/Medline, Scopus, Lilacs e SciELO, sem data inicial até dezembro de 2010. Os descritores foram extraídos do Medical Subject Headings e incluíram "respiratory function tests" e "childhood obesity". SINTESE DOS DADOS: Por meio da estratégia de busca, 89 artigos foram encontrados, dos quais apenas cinco foram selecionados. Foram incluídos estudos observacionais com descrição dos parâmetros espirométricos e do índice de massa corpórea, sendo excluídos estudos com outros métodos de avaliação da função pulmonar, população não exclusiva de crianças/adolescentes e presença de comorbidades associadas à obesidade. Para avaliação da qualidade dos estudos utilizou-se a escala para estudos observacionais da Agency for Healthcare Research and Quality. Os estudos avaliaram a capacidade vital forçada e o volume expiratório forçado no primeiro segundo. Quatros artigos avaliaram também o fluxo expiratório forçado entre 25 e 75%, aquele em 50%, o pico de fluxo expiratório e a relação entre o volume expiratório forçado no primeiro segundo e a capacidade vital forçada. CONCLUSÕES: Os artigos mostram evidências significativas de associação entre a diminuição dos valores de capacidade vital forçada e volume expiratório forçado no primeiro segundo com a obesidade em crianças e adolescentes.

OBJECTIVE: To perform a systematic review of observational studies that analyzed the relation between spirometric parameters and the presence of obesity in children and adolescents. DATA SOURCE: Data were selected without language restriction, using the following databases: PubMed/Medline, Scopus, Lilacs, and SciELO, with no restriction as to initial date until December 2010. The descriptors were extracted from Medical Subject Headings: "respiratory function tests" and "childhood obesity". SYNTHESIS OF DATA: 89 papers were initially found, but only five were selected. Observational studies reporting spirometric parameters and body mass index of the patients were included, and those that assessed pulmonary function by other methods and whose subjects were not exclusively children or enrolled patients with associated comorbidities were excluded. In order to assess the quality of these studies, the scale for observational studies of the Agency for Healthcare Research and Quality was applied. All studies evaluated the forced vital capacity and the forced expiratory volume on the first second. Four papers also assessed the forced expiratory flow between 25 and 75%, forced expiratory flow at 50%, expiratory peak flow, and the relation between forced expiratory volume on the first second and forced vital capacity. CONCLUSIONS: The studies show consistent data and evidence of association between decreased spirometric values of forced vital and capacity and forced expiratory volume on the first second with obesity in children and adolescents.

OBJETIVO: Realizar una revisión sistemática sobre los estudios observacionales que analizaron la relación entre los parámetros espirométricos y la obesidad en niños y adolescentes. FUENTES DE DATOS: Los datos fueron seleccionados sin restricción de idioma, utilizándose las bases de datos PubMed/Medline, Scopus, Lilacs y Scielo, sin fecha inicial hasta diciembre de 2010. Los descriptores fueron extraídos del Medical Subject Headlings e incluyeron ®respiratory function tests¼ y ®childhood obesity¼. SÍNTESIS DE LOS DATOS: Por medio de la estrategia de búsqueda, se encontraron 89 artículos, de los que solamente cinco fueron seleccionados. Se incluyeron estudios observacionales con descripción de los parámetros espirométricos y del índice de masa corporal, siendo excluidos estudios con otros métodos de evaluación de la función pulmonar, población no exclusiva de niños/adolescentes y presencia de comorbidades asociadas a la obesidad. Para evaluación de la calidad de los estudios, se utilizó la escala para estudios observacionales de la Agency for Healthcare Research and Quality. Los estudios evaluaron la capacidad vital forzada y el volumen espiratorio forzado en el primer segundo. Cuatro artículos evaluaron también el flujo espiratorio forzado entre 25 y 75%, aquél en 50%, el ápice de flujo espiratorio y la relación entre el volumen espiratorio forzado en el primer segundo y la capacidad vital forzada. CONCLUSIONES: Los artículos muestran evidencias significativas entre la reducción de los valores de capacidad vital forzada, volumen espiratorio forzado en el primer segundo y viceversa, con la obesidad en niños y adolescentes.