Exercise Therapy – ABC CARDIOL

IJCS

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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Original Article

Continuous Aerobic Training and High Intensity Interval Training Increase Exercise Tolerance in Heart Failure Patients: A Retrospective Study

Diego Busin et al. Alexandre M. Lehnen Olga S. Tairova Eduardo P. Comparsi … Daniela Carneiro Micael Potter Luís F. Deresz Pedro Dal Lago Ramiro B. Nunes

Abstract

Background:

Conventional aerobic training is the first choice in cardiac rehabilitation for patients with chronic heart failure (CHF). However, high-intensity interval training (HIIT) may be an alternative, although it has little evidence.

Objectives:

To evaluate the effect of continuous aerobic training (CAT) or HIIT on exercise tolerance in CHF patients.

Methods:

Retrospective study with 30 patients, of both genders, members of a 10-week CAT or HIIT program. The control group (CON) consisted of patients who did not participate voluntarily in the program. Peak oxygen uptake (VO2peak), thresholds (LV1 and LV2), and ventilatory efficiency in the production of dioxide (VE/VCO2 slope), oxygen uptake efficiency (OUES), and VO2 recovery kinetics were analyzed. A two-way or repeated measures ANOVA was used, followed by Fisher’s post-hoc test (p<0.05).

Results:

After 10 weeks of training, the CAT group increased the treadmill speed at LV1 (p=0.040), while the HIIT increased both the speed (p=0.030) and incline of the treadmill (p<0.001) for VO2peak and LV2, as well as the total time of the cardiopulmonary test. The VE/VCO₂ slope was lower than that predicted for CAT (p=0.003) and HIIT (p=0.008). There was no change in VO₂peak, recovery of heart rate (HR), and VO₂, VE/VCO₂, and OUES in both groups.

Conclusions:

After 10 weeks, both CAT and HIIT increased the tolerance to physical exercise. However, HIIT showed improvement in more parameters, differently from CAT.

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Brief Communication

Jorge Pinto Ribeiro: a True Icon of Exercise Physiology and Cardiology

Ricardo Stein

The initiative to make an edition dedicated to a certain area of knowledge in a scientific journal is always a major challenge full of hard work. Original articles, reviews and / or special cases in the field are expected and the best experts in the subject are those that the editor hopes to be able to count. This edition of the International Journal of Cardiology Science, headed by Dr. Claúdio Gil Soares de Araújo, is focused on physical exercise and its pages contain different articles on the matter. Probably, I was invited to contribute because I work and publish in the sports and exercise cardiology field, besides the fact that I am the Associate-Editor for exercise and rehabilitation of the Arquivos Brasileiros de Cardiologia. By the way, when the invitation letter arrived, I immediately accepted it, but wondered what my ideal contribution might be. Thus, over five days I glimpsed different possibilities, until one early morning, while running an insight came: Jorge Pinto Ribeiro!!! Nothing is fairer to remember than a professor and scientist with more than 150 publications, at least half of them in the exercise physiology/cardiology area. So, with the support of the International Journal of Cardiology Science Editors I was able to go through a few lines with a sense of affection and sadness, as long as many years have passed since this cardiology “giant” passed way. It is amazing to mention that, despite the hiatus of more than 6 years since his death, he continues to publish: at least three articles with his name can be found at Pubmed in the year 2018… and two^, in this Edition!!! Well, but who was the Jorge Pinto Ribeiro I met? The differential started with the name. At least for me an affirmative name. A name that always sounded strong, announcing that behind these 17 letters, Jorge Pinto Ribeiro, came a winner. No, actually, he was a champion. A champion at home, at work, at leisure, a blessed champion with unified qualities in a rare individual, a true winner. A man who was always offering the hand to help others on their achievements. Yes, he was the owner of this name, a person who at the height of his 57 years, in the distant year of 2012, left us. Indeed, after a Herculean fight against a rare disease, the flame of his intense and successful life was extinguished. Actually, his early departure left an enormous emptiness and deep longing in relatives, friends, colleagues, students and patients. However, we who know him well always remember his energy, his production, his life as a husband, father, brother, doctor, teacher… as a friend!!! Is evident, he was a man who lived the life. In short, as a brilliant cardiologist and one of the most talented scientists in exercise physiology/cardiology ever, Jorge Pinto Ribeiro certainly is reading the International Journal of Cardiology Science pages delighted and smiling.

Ricardo “Pinto Ribeiro” Stein

[…]

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Review Article

Measuring Heart Rate During Exercise: From Artery Palpation to Monitors and Apps

Marcos Almeida et al. Altamiro Bottino Plínio Ramos Claudio Gil Araujo

Abstract

The use of technology has increased tremendously, by means of more reliable, smaller, more accessible and specially more user-friendly devices, which provide a wider range of features, and promote significant benefits for the population and health professionals. It is in this context that monitors and apps for heart rate (HR) measurement have emerged. HR is a clinical vital sign of diagnostic and prognostic importance. In response to body movement, HR tends to increase, in a direct relationship with the intensity of exercise. HR was primarily measured by the count of arterial pulse, and recently, HR can be precisely measured by monitors, bracelets and smartphone apps capable to perform real-time measurements and storage of data. This paper aimed to make a brief and updated review on the theme, providing a broader view of advantages and limitations of these resources for HR measurement in exercise. HR monitors and apps use basically two types of technology, optical sensor (photoplethysmography) and electrical signal from the heart. In general, these devices have shown good accuracy in measuring HR and HR variability at rest, but there are differences between brands and models considering the type, mode and intensity of exercise. HR measurements by monitors and smartphone apps are simple, accessible and may help cardiologists in the monitoring of the intensity of aerobic exercise, focusing on health promotion and on primary and secondary prevention of cardiovascular diseases.

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Viewpoint

Exercise, Sports & Cardiovascular Health: Relevant Questions and Answers

Claudio Gil Araujo et al. Barry Franklin Jari Laukkanen Jonathan Myers … Josef Niebauer Jurgen Scharhag Philip J. Millar

Introduction

Currently, it is quite common for a clinical cardiologist to be questioned about exercise and sports, topics that are rarely discussed during formal medical education. In this regard, there is a clear need to access high-quality data and evidence-based information to give patients and family members the best advice.

Aiming to present the state-of-the art scientific information on the topic, we have invited several experts from different countries, all of them “knowledge-producers” in exercise and sports cardiology, to contribute with their expertise by answering specific and relevant questions in the matter. The answers were limited to about 250 words and they were asked to preferentially refer to their own publications.

[…]

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Original Article

Physical Activity and Incidence of Atrial Fibrillation – Systematic Review and Meta-Analysis

Daniel Carlos Garlipp et al. Raphael Boesche Guimaraes Simone Louise Savaris Clovis Froemming Junior … Oscar Dutra Tiago Luiz Luz Leiria

Abstract

Background:

The relationship between exercise and atrial fibrillation (AF) is controversial.

Objectives:

To analyze the effects of physical activity on the incidence of atrial fibrillation using systematic review and meta-analysis.

Methods:

Systematic review and meta-analysis of studies that relate physical exercise and atrial fibrillation. The following databases were searched: PubMed, BVS Saúde and Cochrane. The following descriptors were used: “atrial fibrillation”, “exercise”, “physical activity” and “exercise therapy”. All prospective, retrospective, cross-sectional and cohort studies were investigated. All statistical analyzes were provided using Review Manager 5.3 to provide the mean difference (MD) and relative risk (RR) ratio with 95% confidence intervals (95% CI). The statistical method of heterogeneity index was used to assess heterogeneity. Level of significance was 5%.

Results:

Combined analysis of 11 studies totaling 276,323 participants aged between 12 and 90 years did not suggest a significant increase in AF in individuals submitted to physical exercise (RR = 0.914, 95% CI = 0.833-1.003, heterogeneity: p < 0.001).

Conclusions:

Physical exercise, lato sensu, without stratification by intensity, sex or age does not seem to be associated with an increase of atrial fibrillation.

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Original Article

CLINIMEX Aerobic Fitness Questionnaire: Proposal and Validation

Claudio Gil S. Araújo et al. Claudia Lucia Castro João Felipe Franca Christina Grüne de Souza e Silva

Abstract

Background:

Cardiorespiratory (aerobic) fitness is strongly and directly related to major health outcomes, including all-cause mortality. Maximum oxygen uptake (VO₂max), directly measured by maximal cardiopulmonary exercise test (CPET), represents the subject’s aerobic fitness. However, as CPET is not always available, aerobic fitness estimation tools are necessary.

Objectives:

a) to propose the CLINIMEX Aerobic Fitness Questionnaire (C-AFQ); b) to validate C-AFQ against measured VO₂max; and c) to analyze the influence of some potentially relevant variables on the error of estimate.

Methods:

We prospectively studied 1,000 healthy and unhealthy subjects (68.6% men) aged from 14 to 96 years that underwent a CPET. The two-step C-AFQ describes physical activities with corresponding values in metabolic equivalents (METs) – ranging from 0.9 to 21 METs.

Results:

Application of C-AFQ took less than two minutes. Linear regression analysis indicated a very strong association between estimated (C-AFQ) and measured (CPET) maximal METs – r2 = 0.83 (Sy.x = 1.63; p < .001) – with median difference of only 0.2 METs between both values and interquartile range (percentiles 25 and 75) of 2 METs. The difference between estimated and measured METs was not influenced by age, sex, body mass index, clinical condition, ß-blocker use or sitting-rising test scores.

Conclusion:

C-AFQ is a simple and valid tool for estimating aerobic fitness when CPET is unavailable and it is also useful in planning individual ramp protocols. However, individual error of estimate is quite high, so C-AFQ should not be considered a perfect substitute for CPET’s measured VO₂max.

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Editorial

Continuous Aerobic and High-Intensity Interval Exercise: Which one Produces greater Post-Exercise Hypotension?

André L. Teixeira and Lauro C. Vianna

Exercise training is a key recommendation for maintenance of a healthy life style. It is well established that regular physical exercise provides innumerous physiological and psychological benefits not only to young healthy subjects, but also individuals with diabetes, heart failure, Parkinson disease, multiple sclerosis, claudication, autonomic failure, hypertension, among others. A well-documented physiological response to exercise is called post-exercise hypotension (PEH), in which a single bout of exercise leads to a decrease in arterial blood pressure. The first study showing PEH was published in 1898 by Dr. L. Hill. Thereafter, several authors confirmed these results showing that a single bout of exercise can reduce arterial blood pressure below pre-exercise values. However, one question that remains to be answered is which exercise modality produces greater PEH?

Previous studies have shown that continuous aerobic (CONT) exercise, high-intensity interval (HIIE) training, isometric exercise and resistance-based exercise can lead to a PEH. Studies comparing CONT and HIIE showed that the magnitude of PEH was slightly superior following HIIE compared with CONT exercise.^, However, in these studies, the exercise protocols were not matched by volume. This is important because longer exercise duration and higher-intensity exercise results in greater decreases in arterial blood pressure and longer PEH duration when compared with a short bout of low-intensity exercise.^,

[…]

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Original Article

Influence of Pulmonary Rehabilitation on Clinical Characteristics in Patients with Chronic Heart Failure and Chronic Obstructive Pulmonary Disease

Ganna S. Smyrnova et al. Tetiana M. Babkina Gennadii G. Taradin Mykola T. Vatutin

Abstract

Background:

The improvement of treatment strategies in patients with chronic obstructive pulmonary disease (COPD) and especially with comorbid pathology should provide rational conversion of standard schemes of therapy and rehabilitation in accordance with their clinical, pathogenic, functional and economic feasibility.

Objective:

To assess the influence of pulmonary rehabilitation on clinical characteristics in patients with chronic heart failure (CHF) and concomitant COPD.

Methods:

The study included 102 patients with CHF and concomitant COPD (males, 62%; mean age, 68.2 ± 4.5 years). All patients were divided into two groups: control group (CG) (n = 54), received only standard therapy of CHF and COPD; and intervention group (IG) (n = 48) were additionally taught the full yogic breathing as a program of pulmonary rehabilitation. Calculation of points by clinical evaluation scale (CES), assessment of CHF functional class (FC) (NYHA) and 6-minute walk test (6MWT – with the evaluation of dyspnea by the Borg scale) were performed in all patients on admission to the department and at discharge. Significant association was defined by p value < 0.05.

Results:

At baseline, there were no significant differences in clinical characteristics of the patients and studied parameters between the groups. At discharge both groups showed significant reduction of dyspnea by the Borg scale (in CG: from 7.2 ± 0.8 points to 5.2 ± 0.3; in IG: from 7.4 ± 0.6 points to 3.2 ± 0.4), the number of points by CES (in CG: from 10.8 ± 0.3 points to 7.2 ± 0.4; in IG: from 10.7 ± 0.6 points to 5.9 ± 0.6). Increase in exercise tolerance (by the distance of 6MWT) was observed in both groups (in CG: from 215 ± 24 m to 275 ± 22 m; in IG: from 219 ± 21 m to 308 ± 24 m). The changes were more significant in IG compared to CG. We observed the prominent decrease in CHF FC and length of hospital stay in IG.

Conclusions:

Application of full yogic breathing as the program of pulmonary rehabilitation in addition to standard therapy of the patients with CHF and COPD is associated with a significant decrease in CHF FC, an increase in exercise tolerance and a reduced length of hospital stay.

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