exercise – ABC CARDIOL

IJCS

Review Article

Home-Based Vs. Usual and Center-Based Cardiac Rehabilitation: Effects on Aerobic Fitness and Quality of Life

Cauã Teixeira Mota et al. Claudia Lucia de Moraes Forjaz

Abstract

Home-based cardiac rehabilitation has been proposed as an alternative to expand access to treatment for patients with cardiovascular diseases. This systematic review evaluated the effects of home-based cardiac rehabilitation, with emphasis on physical exercise, on aerobic fitness, quality of life, and adverse events compared with usual cardiac rehabilitation and center-based cardiac rehabilitation. A literature search was conducted in the PubMed database, including only randomized controlled clinical trials involving adults and older adults with coronary artery disease or heart failure. Twenty-three studies conducted in different countries were identified; however, none was performed in Brazil. The total sample comprised 2,298 participants, of whom 24% were women. All studies implemented aerobic training, either alone or combined with resistance training, and the vast majority maintained remote contact with participants every one to two weeks. Comparisons between pre- and post-intervention outcomes showed that home-based cardiac rehabilitation improved aerobic fitness and/or quality of life in 22 studies, with greater improvements than those observed with usual cardiac rehabilitation and outcomes comparable to those achieved with center-based cardiac rehabilitation. Furthermore, the incidence of adverse events was low and similar across the three rehabilitation models. Overall, home-based cardiac rehabilitation improves aerobic fitness and quality of life more effectively than usual cardiac rehabilitation and provides benefits comparable to those of center-based cardiac rehabilitation without increasing the risk of adverse events, supporting its use in the treatment of cardiovascular diseases. Nevertheless, the absence of studies conducted in Brazil highlights the need for further research on this rehabilitation model in the Brazilian context.

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Original Article

Protocol for Improving Hypertension and Diabetes Control Through Lifestyle Intervention in a Cluster Randomized Clinical Trial

Daisy Motta-Santos et al. Thiago Barbabela de Castro Soares Maria Cecília Ramos de Carvalho Regina Márcia Faria de Moura … Sueli Ferreira da Fonseca Larissa Morelli Ferraz Guimarães Reginaldo Gonçalves Clara Rodrigues Alves de Oliveira Aline Cristine Souza Lopes Milena Soriano Marcolino

Abstract

Background:

Hypertension and Diabetes Mellitus (DM) are prevalent chronic conditions and major risk factors for cardiovascular diseases. Adequate control of these conditions is challenging, and lifestyle changes are crucial to achieving better management.

Objectives:

To evaluate the effectiveness of a multifaceted and multidisciplinary intervention to improve the control of hypertension and DM in the primary care setting.

Methods:

This cluster randomized clinical trial focuses on lifestyle modifications for managing hypertension and DM, addressing gaps in current non-pharmacological interventions. Primary care professionals are trained to promote health education on physical activity and nutrition. Support is provided through a telementoring program, including messaging app communication, biweekly online meetings (teletutoring), and asynchronous teleconsultations. Primary care professionals conduct twice-weekly group activities with structured intensity adjustments and biweekly health education sessions using interactive methods like conversations, games, and group dynamics. For patients unable to join group activities, brief counseling and guidance on unsupervised physical activity are offered.

Results:

The primary outcomes are blood pressure and glycated hemoglobin values. The innovative intervention program aims to empower primary care professionals and reduce barriers to care through lifestyle changes, improved health education, and support systems for both supervised and unsupervised interventions. Conclusions: Supporting primary care professionals through education and remote assistance can enhance the effectiveness of lifestyle interventions, contributing significantly to the control of hypertension and DM in primary care settings. Trial registration: Previously registered with .

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IJCS

Editorial

Strengthening Our Understanding of Muscle Metaboreflex Control in Patients with Coronary Artery Disease: (Dis)association Between Physical Fitness and Hemodynamic Responses

André L. Teixeira

Ischemic Heart Disease remains a leading cause of mortality worldwide. In addition to pharmacologic therapy and coronary revascularization, healthy lifestyle interventions such as diet and exercise are essential components of disease management. Although exercise training is a Class I recommendation for patients with ischemic heart disease, physical exertion is not without risk in this population. Indeed, an exercise stress test is a well-established method for inducing myocardial ischemia. Furthermore, patients with ischemic heart disease often exhibit abnormal cardiovascular responses during exercise, which makes exercise prescription both challenging and potentially risky in this clinical population. Therefore, understanding the physiological mechanisms underlying the altered cardiovascular control at rest and during exercise, as well as the cardioprotective effects of exercise training in patients with ischemic heart disease, is critical for improving treatment strategies and optimizing disease management.

The cardiovascular responses to exercise are orchestrated by several integrative neural control mechanisms, including central command, the exercise pressor reflex, the arterial and cardiopulmonary baroreflexes, and the central and peripheral chemoreflexes. The exercise pressor reflex comprises group III and IV skeletal muscle afferents that discharge in response to mechanical deformation (i.e., muscle mechanoreflex) and the accumulation of metabolic by-products of muscle contraction (i.e., muscle metaboreflex).^, Inputs from group III/IV afferent fibers synapse within cardiovascular control areas in the brainstem that reflexively decrease parasympathetic and increase sympathetic nerve activity, leading to increased Heart Rate (HR), cardiac output, total peripheral resistance, and arterial blood pressure during exercise.^, It has been shown that the blood pressure responses to exercise and metaboreflex activation are directly associated with absolute muscle strength in young, healthy adults.^, Moreover, exercise training-induced improvements in cardiorespiratory fitness can modulate metaboreflex control. Nevertheless, the extent to which the cardiovascular responses to muscle metaboreflex activation are related to markers of physical fitness in patients with Coronary Artery Disease (CAD) is currently unknown.

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IJCS

Original Article

Home-based Virtual Reality Exercise Program During the Maintenance Stage of Cardiac Rehabilitation: A Randomized Controlled Trial

Ágata Vieira et al. Cristina Melo Andreia Noites Jorge Machado Joaquim Mendes

Abstract

Background:

Home-based virtual reality technology may become an alternative to cardiac rehabilitation.

Objectives:

To evaluate the effects of a specific, home-based exercise program, performed either through a virtual reality (Kinect) or a conventional format (booklet) in the maintenance stage of cardiac rehabilitation for six months on functional muscle strength of the lower limbs, physical activity and exercise tolerance.

Methodology:

This is a randomized clinical trial (ClinicalTrials.gov — NCT02753829) with individuals with coronary artery disease from a hospital in Porto, Portugal, randomly allocated to an experimental group “1” (EG1; n = 11), submitted to a virtual reality exercise program (Kinect); an experimental group “2” (EG2; n = 11), submitted to an exercise program described in a booklet (conventional format); or a control group (CG) (n=11), submitted to routine care. Parameters of functional muscle strength of the lower limbs (sit-to-stand test), physical activity (accelerometer) and exercise tolerance (stress test) were assessed and compared between the groups. Descriptive and inferential statistics were applied, with 95% with a significance level of 0.05.

Results:

Significant improvements in functional muscle strength of the lower limbs were observed in EG1 compared to EG2, at three months (19.5 ± 7.7 versus 11.9 ± 4.7, p = 0.042), and at six months (23.0 ± 7.7 versus 14.6 ± 4.6, p = 0.027) of intervention.

Conclusions:

The program did not demonstrate superior results, in relation to the control group and among the different formats, in physical activity and effort tolerance. In relation to the functional muscle strength of the lower limbs, the virtual reality format showed significantly better results when compared to the conventional format only.

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IJCS

Editorial

Adding the Exercise Test as a Tool in the Medical Decision-Making Process in Brugada Syndrome

Luiz Eduardo Mastrocola et al. Fábio Mastrocola

Introduction

Most cases of sudden cardiac arrest (SCA) and sudden cardiac death (SCD) are caused by ventricular tachyarrhythmias, with most of these associated with structural heart disease, particularly coronary heart disease. SCA is an uncommon occurrence in the apparently normal heart and accounts for only 5 to 10 percent of total cases.

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IJCS

Editorial

Weight Excess: The Great Villain in the Development of Hypertension in Adolescents

Erika Maria Gonçalves Campana et al. Maria Eliane Campos Magalhães Andréa Araujo Brandão

The relationship between arterial hypertension (AH) and excess weight in young populations is well established. This association involves several conditions including hyperinsulinemia, altered adipokine profile, elevated markers of subclinical inflammation, and inadequate habits, including physical inactivity.^–

In a study^– conducted in the city of Rio de Janeiro, Brazil, an increased body mass index in adolescents was correlated with a higher prevalence of elevated blood pressure (BP) and higher risk of developing AH at young adult age. From a longitudinal perspective, an interesting aspect in the assessment of cardiovascular risk factors is the tracking effect, in which children and adolescents with altered clinical and metabolic parameters (BP, body mass index and cholesterol levels) are likely to maintain an abnormal profile of these variables throughout life and become adults at increased cardiovascular risk.^– This fact highlights the continuous, unfavorable impact of persistent obesity from childhood to adulthood on cardiovascular risk factors.

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IJCS

Editorial

Small Exercise Breaks can Save your Brain from Prolonged Sitting

A sedentary lifestyle is one of the major risk factors for the development of cardiovascular diseases. For instance, in 2019, stroke was the second-leading cause of death, as well as the primary cause of death and disability combined in the world. Active commuting to work is one strategy to decrease sedentary time and its impact, and the COVID-19 pandemic has changed work and daily routines worldwide. Moreover, the necessary social distancing has led to increased sedentary time, especially for those who are engaged in office desk work .

Acute prolonged sitting seems to lead to transient impairment of the endothelial function in the healthy population, whether this phenomenon is related to cardiovascular or cerebrovascular events is unknown. Nonetheless, prolonged sitting impairs the cerebrovascular function.^, Conversely, exercise breaks from prolonged sitting seem to restore the endothelial and cerebrovascular function. Therefore, active breaks from prolonged sitting could be a good strategy to mitigate the effects of sedentary time. However, the ideal duration and intensity need further investigation. Additionally, the difficulty to implement exercise breaks as a daily routine for office workers must be considered.

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Original Article

Effects of Physical Exercise on Left Ventricular Function in Type 2 Diabetes Mellitus: A Systematic Review

Ariane Petronilho et al. Mariana de Oliveira Gois Camila Sakaguchi Maria Cecília Moraes Frade … Meliza Goi Roscani Aparecida Maria Catai

Abstract

Background

The incidence of diabetes mellitus in younger adults is rising over the years. The diabetic population has an increased risk of developing heart failure, and diabetic individuals with heart failure have four times greater mortality rate. Studies results about exercise effect on left ventricular function in type 2 diabetes mellitus are heterogenous.

Objective

This review aimed to analyze the effects of physical exercise on left ventricular dysfunction in type 2 diabetes mellitus (T2DM).

Methods

Only randomized clinical trials with humans published in English were included. Inclusion criteria were studies with type 2 diabetes patients, physical exercise, control group and left ventricular function. Exclusion criteria were studies with animals, children, teenagers, elderly individuals and athletes, presence of diet intervention, and patients with type 1 diabetes, cancer, cardiac, pulmonary, or neurological diseases. Electronic databases PubMed, Web of Science, Cochrane, and Scopus were last searched in September 2021. Risk of bias was assessed by the Physiotherapy Evidence Database (PEDro) scale.

Results

Five studies were included, representing 314 diabetic individuals submitted to resistance and aerobic exercise training. Of the variables analyzed, physical exercise improved peak torsion (PTo), global longitudinal strain, global strain rate (GSR), time to peak untwist rate (PUTR), early diastolic filling rate (EDFR) and peak early diastolic strain rate (PEDSR).

Conclusion

To our knowledge, this is the first systematic review on the effects of exercise on left ventricular function in T2DM including only randomized clinical trials with humans. Physical exercise seems to improve systolic and diastolic strain, twist, and torsion. High intensity exercise was reported to be superior to moderate intensity exercise in one study. This review was limited by the small number of studies and their heterogeneity regarding exercise protocols, follow-up period, exercise supervision and left ventricular function variables analyzed. This review was registered in PROSPERO (CRD42021234964).

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Editorial

Can Exercise Training Prevent Doxorubicin-induced Cardiomyopathy?

Marcus Vinicius Machado et al. Ronan Chapuis Aline Bomfim Vieira

Doxorubicin (DOX) is a cytotoxic antineoplastic agent of the anthracycline family. It has been used as the first-line chemotherapy drug for treating various types of cancer, such as breast, lung and bladder cancer, and lymphoblastic leukemia. As any anthracycline, DOX is an effective chemotherapeutic drug. However, it holds a potentially lethal dose-dependent cardiovascular toxicity, which can manifest immediately or many years after chemotherapy, limiting its clinical application.

After the discontinuation of DOX treatment, a seven-year follow-up of 1,807 patients reported 33% death from heart diseases. Similarly, a 7.5% incidence of some cardiomyopathies was reported in pediatric sarcoma patients within an average of 34 months post-DOX treatment.

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Original Article

Effects of Exercise Training on Left Ventricular Diastolic Function Markers in Patients with Obstructive Sleep Apnea: A Randomized Study

Bruno G. Durante et al. Rosyvaldo Ferreira-Silva Thiago T. Goya Marta F. Lima … Ana Clara T. Rodrigues Luciano F. Drager Camila P. Jordão Amanda G. Rodrigues Maria Janieire de Nazare N. Alves Geraldo Lorenzi-Filho Carlos E. Negrão Linda M. Ueno-Pardi

Abstract

Background

Exercise training (ET) is an adjunctive treatment for obstructive sleep apnea (OSA) and its consequences. However, the effects of exercise on heart remodeling are unknown in the population with OSA.

Objective

We investigated the effect of ET on markers of diastolic function, sleep parameters, and functional capacity in patients with OSA.

Methods

Sedentary patients with OSA (apnea-hypopnea index, AHI ≥15 events/hr) were randomly assigned to untrained (n=18) and trained (n=20) strategies. Polysomnography, cardiopulmonary exercise test, and echocardiography were evaluated at the beginning and end of the study. ET consisted of 3 weekly sessions of aerobic exercise, resistance exercises, and flexibility training (72 sessions, completed in 11.65±0.86 months). A two-way analysis of variance (ANOVA) was used, followed by Tukey’s post-hoc test. The level of statistical significance was set at p<0.05 for all analyses.

Result

Thirty-eight patients were included (AHI:45±29 events/hr, age:52±7 y, body mass index: 30±4 kg/m²). They had similar baseline parameters. ET caused a significant change in OSA severity (AHI:4.5±18 versus -5.7±13 events/hr; arousal index:1.5±8 versus -6.1±13 events/hr, in untrained and trained groups respectively, p<0.05). The trained patients had an increase in functional capacity after intervention. ET improved isovolumetric relaxation time (IVRT, untrained=6.5±17.3 versus trained=-5.1±17.1 msec, p<0.05). There was a significant correlation between changes in IVRT and arousal index in the trained group (r =-0.54, p<0.05). No difference occurred in the other diastolic function parameters evaluated.

Conclusion

ET promotes modest but significant improvement in AHI, functional capacity, and cardiac IVRT, a validated parameter of diastolic function.

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Original Article

Physical Training Improves Cardiac Structure and Function of Rats After Doxorubicin-Induced Cardiomyopathy

Fernanda Rodrigues Souza et al. Érica Carolina Campos Leandro Teixeira Paranhos Lopes Clesnan Mendes Rodrigues … Danilo Lemes Naves Gonçalves Marcelo Emílio Beletti Matheus Matioli Mantovani Poliana Rodrigues Alves Duarte Alexandre Gonçalves Elmiro Santos Resende

Abstract

Background:

The use of doxorubicin in chemotherapy has been associated with cardiotoxicity and heart failure. Physical exercise produces favorable morphofunctional adaptations in the cardiovascular system and may reverse cardiac dysfunction in patients undergoing chemotherapy.

Objective:

To assess the effects of physical training on myocardial structure, cardiac function, and exercise tolerance in Wistar rats initiated after the onset of cardiotoxicity-induced cardiotoxicity.

Methods:

This study investigated 30 adult male Wistar rats randomly divided into four groups: control (C), exercise (EX), doxorubicin (DX), and doxorubicin and exercise (DXEX). The DX and DXEX groups received six doses of doxorubincin from 1.25 mg/kg body weight up to a cumulative dose of 7.5 mg/kg. Injections were administered intraperitoneally three times a week for two weeks; after this stage, the EX and DXEX groups started physical training (swimming) sessions three times a week with a load of 5% of their body weight. Echocardiography and exercise tolerance tests were performed. Generalized linear models were used in statistical analysis, and a p<0.05 was set as statistically significant.

Results:

Left ventricular shortening fraction and ejection fraction were reduced in the DX group compared to C, EX, and DXEX. The DXEX group showed greater tolerance to effort when compared to the DX and C groups.

Conclusion:

Physical training, initiated after the onset of doxorubicin-induced cardiotoxicity, improved cardiac function and exercise tolerance in rats.

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Case Report

Exercise-Induced Bronchoconstriction: A Frequent, but Neglected Cause of Chest Pain

Renata Rodrigues Teixeira de Castro et al. João Giffoni Silveira Neto Adalgiza Mafra Moreno Marco Orsini

Introduction

Chest pain is one of the most common complaints in emergency departments, and internal medicine and cardiology clinics. Patients’ comorbidities and the clinical characterization of chest pain are cornerstones to guide symptom differentiation. Information about pain intensity, duration, localization, changes with posture/movement, and its reaction to nitroglycerin helps diagnose cardiac chest pain. Typical angina pectoris is the presence of substernal chest pain or discomfort provoked by exertion or emotional stress, and is relieved by rest and nitroglycerin. Angina pectoris is attributed to myocardial ischemia due to the unbalance between myocardial oxygen supply and myocardial oxygen demand elicited during exercise or emotional stress.

The diagnosis and treatment workup in patients with moderate to high cardiovascular risk presenting angina pectoris is quite straight-forward. Nevertheless, exertional chest pain in a young man can be challenging and yield a common but overlooked diagnosis, as in the present case report.

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Editorial

We need to talk about why we don’t talk about exercise!

Fabrício Braga da Silva

We usually avoid subjects that make us feel uncomfortable. As in general these subjects are those we cannot deal with, the consequences of such omission can be really bad. Problems with our children are classical examples of topics we avoid. Published in 2003, “We Need to Talk About Kevin” is a novel written by Lionel Shriver, adapted to the big screen in 2011. The film addresses the vicious cycle of problems caused by the mother who neglects her child with overt psychopathy, culminating in a catastrophe. In this fiction, avoiding the subject cost the lives of many people.

This introductory metaphor was the preamble to the following question: based on available evidence, why do we not have proper conversation about exercise with our patients? Why is physical exercise little addressed in medical visits? Why are healthcare providers not concerned about individual and collective consequences of physical inactivity?

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Editorial

Exercise Testing Protocols to Detect the Presence of Coronary Artery Disease: Bruce or Ramp?

Ricardo Vivacqua Cardoso Costa

The investigation of ischemic response through clinical, metabolic, hemodynamic, and electrocardiographic parameters displayed in the exercise stress test (ET) in multifactorial analysis increases the ET’s diagnostic and prognostic accuracy indication of ischemic response.

Coronary artery disease (CAD) is a pathology that requires quick and safe decisions for the patient, and it is always a challenge. The protocols for performing the ET, whether on a cycle ergometer or a treadmill, must be adapted to the patient’s biomechanical conditions so that they are comfortable and can reach the criteria that define a maximum or close to the maximum effort level. The protocol must seek a satisfactory mobilization of myocardial reserves so that the sensitivity to the presence of an ischemic response can be increased.

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Editorial

Exercise Is Medicine! How to Safely Return to Sports after COVID-19? A Meta-Analysis and a Practical Flowchart for Cardiovascular Risk Assessment may Help you

Exercise is medicine! Although this premise is well established, how to maintain this “treatment” for various diseases during the COVID-19 pandemic? This has been a concern of all doctors in the world since exercise contributes to the control of cardiovascular diseases and other comorbidities recognized as risk factors for a worse outcome in COVID-19. Moreover, it has already been shown that higher cardiorespiratory fitness is inversely associated with the likelihood of hospitalization due to COVID-19.

In addition to the hygiene and social distancing measures necessary to prevent coronavirus infection, cardiovascular sequelae in individuals recovering from COVID-19 may contribute to the delay in resuming exercise. Cardiovascular complications, including myocarditis, are relatively common in patients affected by SARS-CoV-2. Although the occurrence of myocarditis as a consequence of COVID-19 was initially described in hospitalized patients with severe presentation of the disease, subsequent studies have reported its occurrence in individuals with mild COVID-19 and even in asymptomatic patients.

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Viewpoint

Physical Activity, Obesity, and COVID-19: What can we Expect from his Relationship?

Ciro Oliveira Queiroz et al. Ariani França Conceição Paulo Rodrigo Santos Aristides Leandro Silva Alves Rogério Tosta Almeida

The COVID-19 pandemic is a public health problem, whose first cases were found in Wuhan, China, in December, 2019, and which is currently present around the world. COVID-19 is caused by the new coronavirus (SARS-CoV-2), which shows a high potential of contamination. Its transmission occurs through droplets during unprotected proximity with an infected person and contact with contaminated environmental surfaces, which are the main systemic and respiratory symptoms.^,

To date, there is no pharmacological treatment that has proven to be effective, or a vaccine for the prevention or treatment of COVID-19. Thus, a non-pharmacological strategy of public health, which has shown effectiveness in the exponential control of the disease, is social distancing, which encompasses the isolation of cases, quarantine of contacts, and the voluntary practice of not going to crowed places. These measures have demonstrated that they can reduce mortality rates during the pandemic, and they have helped in governmental decision-making.^,

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Viewpoint

Physical Activity and Cardiovascular Health: Practical Strategies to Reduce Sedentary Time in Adult Population

Karolinny Borinelli de Aquino Moura et al. Simone Savaris Janice Debastiani Juliana Beust de Lima

Introduction

Cardiovascular disease (CVD) is highly prevalent worldwide and is the main cause of death in the general population. The practice of physical activity (PA) has emerged as a primary prevention strategy for CVD, with the potential to control risk factors, and promote a better quality of life and longer survival.

However, despite the scientifically proven benefits, and formal recommendations for the practice of PA for adults, ( ), published data on the world population are alarming. Recent estimates indicate that one in four (27.5%) adults worldwide and almost half of the population in Brazil do not follow the recommendations made by the World Health Organization (WHO). Additionally to physical inactivity, the growing prevalence of sedentary behavior is a current concern ( ).

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Original Article

Hypertension and Different Levels of Body Mass Index and Cardiorespiratory Fitness Amongst Adolescents

Cleiton Bertollo et al. Claúdia Daniela Barbian Letícia de Borba Schneiders João Francisco de Castro Silveira … Bruna Dahmer Vogt Elza Daniel de Mello Leandro Tibiriçá Burgos James Philip Hobkirk Cézane Priscila Reuter

Abstract

Background

Hypertension is an increasingly common problem in adolescents; amongst the associated factors, physical inactivity and obesity are increasing the risk of developing cardiovascular diseases.

Objective

To verify whether there is an association between higher blood pressure levels amongst adolescents with the relationship between different levels of body mass index (BMI) and cardiorespiratory fitness (CRF).

Method

Cross-sectional study consisting of 860 adolescents. Higher blood pressure (BP) was considered as borderline and hypertension as the classification. BMI was categorized as low-normal weight and overweight-obesity. The CRF was assessed by a nine-minute run/walk test and classified into low or appropriate levels (less and more favorable to health, respectively). Later, BMI and CRF were grouped into one categorical variable: (I) low/normal weight and appropriate CRF levels; (II) low/normal weight and low CRF levels; (III) overweight/obesity and appropriate CRF levels; and (IV) overweight/obesity and low CRF levels. Data were analyzed using Poisson regression, through the prevalence ratio (PR) and 95% confidence intervals (CI). The p-values of p <0.05 were considered significant.

Results

Adolescents with overweight/obesity and low CRF levels had a 22% higher BP prevalence. Moreover, children with overweight/obesity, but with appropriate CRF levels, have a 15% higher BP prevalence.

Conclusion

Adolescents with overweight/obesity had a higher prevalence of BP, regardless of CRF levels. It is suggested that maintaining normal BMI is a protective factor for less favorable BP.

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Editorial

Exercise-based Cardiovascular Rehabilitation in Chronic Heart Failure: does Exercise Intensity Matter?

Gabriel Dias Rodrigues

It is well recognized that chronic heart failure (CHF) is a multifactorial syndrome that reduces physical exercise tolerance. Exercise-based cardiac rehabilitation program is on the frontline of non-pharmacological therapies for CHF patients, counterbalancing the disease-induced issues of physical capacity.

Since a successful exercise rehabilitation program should be efficient and safe, the search for optimal combinations of exercise volume and intensity has sparked interest in the current literature. Although studies have shown feasible combinations of low volume and high intensity, and vice versa, the optimal dose-response of exercise in cardiovascular rehabilitation remains unknown. Classically, aerobic training with moderate intensity (i.e., between 60% and 80% VO_2peak or heart rate reserve – HRreserve) is a safe approach to improve physical capacity and provide a cardioprotective effect in CHF disease. As a promising method, short bouts of high-intensity exercise, called high-intensity interval training, seems to be superior than moderate continuous training to reverse left ventricle remodeling and improve aerobic capacity, endothelial function, and quality of life in post-infarction heart failure patients.

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Original Article

Comparison between Bruce and Ramp Protocols for Exercise Testing in the Diagnosis of Myocardial Ischemia

Thiago Teixeira da Silveira Fagundes et al. Carolina Christianini Mizzaci Susimeire Buglia Fabricio da Costa Wohnrath … Flavia Medina João França Rica Dodo Delmar Buchler Luiz Eduardo Mastrocola Romeu Sérgio Meneghelo

Abstract

Background:

Exercise tests are an important tool in the investigation of myocardial ischemia. The ramp protocol has gained increasing importance in clinical practice because of the possibility of individualizing its exercise intensity.

Objective:

To assess and compare the sensitivity, specificity, and accuracy of Bruce and ramp protocols for exercise testing in the diagnosis of myocardial ischemia considering myocardial perfusion scintigraphy as the reference standard. Secondary objectives included the assessment of hemodynamic profiles, functional capacity, and the incidence of arrhythmias in each of the protocols.

Methods:

Participants underwent exercise testing using the ramp and Bruce protocols, and the tests’ diagnostic power was assessed. For testing the difference between data provided by both protocols, we used a paired Student’s t-test or Wilcoxon test, depending on the assumption of data normality. The level of significance adopted for all tests was 5%.

Results:

The ramp protocol showed sensitivity, specificity, and accuracy values of 55.6%, 82.4%, and 76.7%, respectively, whereas the Bruce protocol had results of 77.8%, 64.7%, and 67.4%, respectively. The maximum heart rate and double product at peak exercise were significantly higher in the Bruce protocol (p = 0.043 and p = 0.040, respectively). No differences were observed between the incidence of arrhythmias in both protocols.

Conclusion:

The Bruce protocol presented higher sensitivity for detecting ischemia on the exercise test, while the ramp protocol presented higher specificity and accuracy.

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Original Article

Lifestyle Intervention in Reducing Cardiometabolic Risk Factors in Students with Dyslipidemia and Abdominal Obesity: A Randomized Study

Heloisa Pamplona-Cunha et al. Nilton Rosini Roberta Caetano Marcos José Machado Edson Luiz da Silva

Abstract

Background

The long incubation periods of cardiovascular diseases offer opportunities for controlling risk factors. In addition, preventive interventions in childhood are more likely to succeed because lifestyle habits become ingrained as they are repeated.

Objective

To investigate the effects of recreational physical activities, in combination or not with a qualitative nutritional counseling, in cardiometabolic risk factors of students with dyslipidemia and abdominal obesity.

Methods

Students (8-14 years old) were randomly divided into three groups (n=23 each): i ) Control; ii ) PANC, students undergoing Physical Activity and Nutritional Counseling, and iii ) PA, students submitted to Physical Activity, only. Blood samples (12-h fasting) were collected for biochemical analysis and anthropometric markers were also assessed. Two-Way RM-ANOVA and Holm-Sidak’s test, and Friedman ANOVA on Ranks and Dunn’s test were applied. P ≤ 0.05 was considered significant. Effect sizes were evaluated by Hedges’ g and Cliff’s δ for normal and non-Gaussian data, respectively.

Results

Compared to the control group and to baseline values, both interventions caused significant average reductions in total cholesterol (11%; p <0.001), LDL-c (19%; p=0.002), and non-HDL-c (19%; p=0.003). Furthermore, students in the PANC group also experienced a significant decrease in body fat compared to baseline (p=0.005) and to control (5.2%; g=0.541).

Conclusions

The proposed strategies were effective to reduce cardiometabolic risk factors in children and adolescents. The low cost of these interventions allows the implementation of health care programs in schools to improve the students’ quality of life.

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Review Article

Effect of Physical Training on Nitric Oxide Levels in Patients with Arterial Hypertension: An Integrative Review

Tábata de Paula Facioli et al. Mariana Colombini Buranello Eloisa Maria Gatti Regueiro Renata Pedrolongo Basso-Vanelli Marina de Toledo Durand

Abstract

The regular practice of physical exercise as a non-pharmacological treatment of arterial hypertension (AH) has been encouraged due to causing a series of physiological responses in the cardiovascular system, such as the production of vasoactive substances, including nitric oxide (NO). NO is a relaxation factor released by the endothelium, and the decrease in its bioavailability is related to coronary and arterial diseases, such as AH. This study aimed to perform an integrative literature review to elucidate the effect of physical training on NO levels in patients with AH and to establish a relationship between these levels and blood pressure (BP) control. A literature review was was performed by searching PubMed / MEDLINE, Lilacs, Scielo, Cinahl and Embase databases. The search string used was (“arterial hypertension” OR hypertension) AND (exercise OR “physical exercise” OR “aerobic exercise” OR “exercise training” or “physical activity”) AND (“nitric oxide”). We included fully available controlled and uncontrolled clinical trials published in English and Portuguese languages in the last 10 years. The review consisted of 16 articles, of which 13 reported an increase in NO production after the physical training intervention, and three studies found no change. In addition, 15 studies observed a reduction in BP after the intervention. In conclusion, regular practice of physical exercises, advocating moderate intensity, can improve NO bioavailability in pre-hypertensive and hypertensive individuals, which seems to be one of the mechanisms responsible for BP reduction.

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Viewpoint

Physical Exercise, Energy Expenditure and Weight Loss: An Assumption not Always Observed in Practice

Vitor Barreto Paravidino et al. Mauro Felippe Felix Mediano Rosely Sichieri

The increased prevalence of overweight and obesity observed in recent decades has been attributed mainly to behavioral changes, such as excessive food consumption and reduction in physical activity level over time, leading to a positive energy balance. Due to the technological advances in recent years, less physical effort is required to perform daily tasks. Moreover, the lifestyle has become more sedentary, with an increasing amount of time spent using digital gadgets, such as computers, televisions and mobile phones. However, Westerterp & Speakman did not find a decrease in physical activity energy expenditure during the last 30 years preceding their study, despite an increase in the prevalence of obesity. Other studies have also reported that the total energy expenditure of rural populations was similar to that of populations living in developed countries, despite the clear difference in behavioral patterns, particularly in relation to daily physical activities.^– This study aimed at presenting the “compensatory effect” as a possible explanation for these findings. When there is an increase in physical activity at a given time, behavioral and metabolic changes take place to maintain an energy setpoint, as presented below.

Physical exercise has been recommended as an important component for the prevention and treatment of obesity. For substantial adults’ health benefits, at least 150 minutes of moderate-intensity aerobic exercise, or 75 minutes of vigorous-intensity aerobic exercise; in addition, 2-3 times per week of resistance training is recommended. However, for a clinically significant reduction in body weight, Donnelly et al., recommended that individuals should gradually increase the amount of physical activity and achieve a weekly volume of moderate physical exercise of over 250 minutes. The authors also reported a dose-response effect between physical activity and weight loss.

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Original Article

Does Hypertension Knowledge Influence Levels of Physical Activity in Hypertensive Patients From a Southern Brazilian Community?

Rafaella Zulianello dos Santos et al. Andrea Schaefer Korbes Eliara Ten Caten Martins Mateus De Lucca … Leonardo De Lucca Marlus Karsten Magnus Benetti

Abstract

Background:

Increased level of physical activity (PA) and health education are known as non-pharmacological treatments of hypertension (HP). There is a lack of studies investigating the influence of HP knowledge on the level of PA among hypertensive patients.

Objective:

To examine the influence of patient’s knowledge about HP on PA level and the relationship between these variables.

Methods:

A cross-sectional study was conducted in in a primary care center located in a city in the southern Brazil. A total of 199 hypertensive patients (median 61.2 [13] years; body mass index (BMI) 21.9 (7.5) kg/m2; 72.4% women) were included. The level of PA was assessed by measuring the number of steps taken daily. The knowledge about HP was assessed by a standardized questionnaire (HIPER-Q). The Kruskall-Wallis test was used to compare age, BMI and PA level between HP knowledge categories, and the Spearman test was used to assess correlations (p <0.05).

Results:

The median score of knowledge about HP for patients categorized as insufficient (n=6, 3%), poor (n=24; 12.1%), acceptable (n=101; 50.8%) and good (n=68; 34.2%) was 11.0 (8.0), 20.0 (4.0), 26.0 (5.0) and 38.0 (2.0), respectively. No patient has achieved an “excellent” level of knowledge. There was no significant difference in PA level (p = 0.341), BMI (p = 0.510) or age (p = 0.073) between these categories. Age was negatively correlated with knowledge about HP (p <0.05 and rho = 0.02).

Conclusions:

Patient’s knowledge about HP did not influence the level of PA in hypertensive patients. Age, number of steps per day and BMI were not significantly different between the categories of knowledge. Public policies and organizational strategy should be addressed to improve health education and avoid sedentary behavior in this population. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0)

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