Sedentarism – ABC CARDIOL

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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Editorial

Small Exercise Breaks can Save your Brain from Prolonged Sitting

Eliza Prodel

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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Editorial

Why is Physical Activity Important to Study in Childhood and Adolescence?

Klebia Castello Branco et al. Isabela de Carlos Back

One of the most important concerns of pediatrician in this pandemic/post-pandemic period is the damage caused by COVID-19 on children’s daily habits, especially physical activity. Children and teenagers were kept indoors during these 2 years, living their lives through digital interactions and becoming forcefully sedentary.

Studies conducted worldwide have shown that the average daily screen time of children and adolescents was greater than 2 hours a day, with the vast majority of them having a higher time than that recommended for any age.

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IJCS

Brief Communication

Increased Maximal Expiratory Pressure, Abdominal and Thoracic Respiratory Expansibility in Healthy Yoga Practitioners Compared to Healthy Sedentary Individuals

Cláudia Fetter et al. Liliane Appratto de Souza Daniela Ravizzoni Dartora Andressa Schein … Bruna Eibel Karina Casali Maria Cláudia Irigoyen

Abstract

Background

Increasing thoracic expansion is effective at reducing blood pressure in hypertensive subjects. Yoga prescribes many respiratory techniques with a growing number of practitioners. However, very little is known whether sedentary or yoga practitioners show measurable differences in their respiratory patterns.

Objective

This study aims to demonstrate differences between healthy sedentary individuals and healthy yoga practitioners regarding maximal respiratory pressures and thoracic and abdominal respiratory expansibility.

Methods

Maximal inspiratory and expiratory pressures (MIP and MEP, respectively) were evaluated by manovacuometry, while respiratory expansion was assessed by the cirtometry of abdominal (CA), thoracic xiphoidal (CTX), and thoracic axillary (CTA) circumferences at rest (end expiratory moment) and at full inspiration in healthy sedentary individuals (SED) and yoga practitioners (YOGA). A delta derived from rest and full inspiration measures (ΔCA, ΔCTX, and ΔCTA, respectively), followed by a percentage of each item (ΔCA/CA, ΔCTX/CTX, and ΔCTA/CTA) was then calculated. Groups were compared by means of an unpaired Student’s t-test, with a significance level p < 0.05.

Results

All respiratory expansion measures were significantly higher in in the YOGA group. A significantly higher MEP (cmH₂O) was also detected in yoga practitioners: SED 89.3 ± 19.3 and YOGA 114.7 ± 24.8 ( p = 0.007), along with decreased heart rate at rest (bpm): SED 84±6 and YOGA 74±15 ( p = 0.001).

Conclusions

Yoga practitioners have shown greater thoracic and abdominal expansion and increased MEP, when compared to healthy sedentary individuals, as well as significantly lower heart rates at rest and body mass index (BMI). However, whether or not these findings are related to respiratory patterns is uncertain.

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Editorial

A Burden of Physical Inactivity in School-Age Students: The Early Beginning of Cardiometabolic Risk

Pedro Paulo da Silva Soares et al. Gabriel Dias Rodrigues

It is well-known that sedentarism has a close association with the risk of cardiovascular and metabolic diseases. The physical inactivity lifestyle contributes to the prevalence of obesity and hypertension in children, highlighting a big health problem since most individuals who were hypertensive and obese in childhood/adolescence become hypertensive and obese adults. On the other hand, physical exercise is a frontline non-pharmacological strategy to control and treat hypertension, as well as to prevent obesity, which should be encouraged among children/adolescents to reduce cardiometabolic risk in adulthood. In this context, the mapping of risk factors associated with hypertension at the early age should be considered a primary step to plan public policies for disease prevention and health promotion, reducing the burden on healthcare resources. Both obesity and high blood pressure have multifactorial causes, among them low levels of physical activity in adults, children, and adolescents. It is of utmost relevance to investigate the prevalence of physical activity levels in scholars, mainly in a country such as Brazil, with enormous disparities among regions.

In the current issue of the International Journal of Cardiovascular Sciences, Azevêdo et al. investigated physical activity levels, as well as the anthropometric and cardiovascular profile in school-age students attending public schools in the state of Sergipe, northeast of Brazil. The study reported high rates of physical inactivity for both boys and girls, and increased blood pressure in overweight school-age students. Regarding anthropometric profiles, intriguing data showed a high prevalence of low body weight in the age group from 16 to 17 years for both sexes. In contrast, a previous study found a high prevalence of overweight/obesity in school-age students in a city of the Brazilian South region, suggesting a discrepancy between the Brazilian South and Northeast regions that must be considered for Brazilian public policies in health promoting at the primary care level. From a practical perspective, physical education classes, as well as the public schools’ pedagogic programs, must work together for health promoting and health education, and physical activity should be encouraged to prevent cardiovascular risk starting from childhood to adult life.

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Original Article

Physical Activity Level, Anthropometric and Cardiovascular Profile Among Students in Sergipe State Attending Public Schools

Luan Morais Azevêdo et al. Lucas Souza Santos Emerson Pardono Jeeser Alves Almeida Aldemir Smith Menezes

Abstract

Background

Cardiovascular diseases are the leading cause of mortality among adults. Evidence has shown that sedentary behaviors are the main preventable outcome, however, many sedentary children also become sedentary adults. Therefore, identifying potential risk factors as early as possible contributes to therapeutic success.

Objective

To achieve an anthropometric and cardiovascular mapping of school-age students from Sergipe State, Brazil.

Methods

A school-based cross-sectional study with a representative sample from public schools in the state of Sergipe (n= 4700). Anthropometric and blood pressure measurements were performed, and the Global School-based Student Health Survey was used to assess the physical activity level. An independent samples t-test was performed for all comparisons, and significance was established at 5% (p<0.05).

Results

Despite showing mean blood pressure values within reasonable limits (SBP = 114.1±12.4 mm Hg and DBP = 66.3±8.1 mm Hg), school-age students did not comply with global recommendations for health promotion. It was also observed a high rate of low body weight (42.6%), suggesting dietary compromises, which can interfere with the development of this population. In addition, only 7.3% of students met the minimum physical activity criteria proposed for maintaining their health status.

Conclusion

The findings of the present study emphasize the importance of maintaining Physical Education classes as an essential curricular component, since they provide several health benefits and ensure that this population reaches the minimum daily recommendations, preventing diseases in adult life. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0)

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Original Article

Treatment Eligibility and Therapeutic Responses of an Ecuadorian Population at High Cardiovascular Risk Based on the ATP III Guidelines

Isabel Hernández et al. Andrea Estrella Jorge Salazar Yan Duarte … Edmundo Torres Camilo López Santiago Terán Alejandra Mendoza Enrique Terán

Abstract

Background

The Adult Treatment Panel III (ATPIII) guidelines aim to reduce cardiovascular morbidity and mortality. In Ecuador, 20% of people have high LDL cholesterol levels, and 39% have high triglyceride levels.

Objective

To analyze lipid-lowering regimens in Ecuadorian patients and determine the achievement rate of the ATPIII goals for lipid profile.

Methods

Using a retrospective analysis, 385 subjects older than 30 years, who received pharmacological treatment for dyslipidemia for at least three months was randomly selected from institutions at two large cities in Ecuador. Data were collected from patients’ medical records and analyzed by chi-square test or paired t-test; p-values less than 0.05 were considered significant.

Results

Baseline total cholesterol values were above 200 mg/dL in 75% of subjects, LDL-c values above 129 mg/dL in 83% of subjects and triglycerides values above 150 mg/dL in 79% of subjects. Most (n = 253, 95.8%) patients at very high cardiovascular risk were taking statins, 50% of them atorvastatin. Considering the ATPIII guidelines’ goals, only 24 subjects (19%) at high CV risk achieved an LDL-c < 100 mg/dl, while a significantly lower percentage (p = 0.04) of patients at very high risk reached an LDL-c < 70mg/dl (11%; n = 30).

Conclusion

These data indicate a low rate of compliance with the ATPIII guidelines, independent of the medication used or duration of the treatment. This may be attributed to the prescription of low doses of medication and a therapy targeting isolated lipid fractions rather than a complete lipid profile. (Int J Cardiovasc Sci. 2020; 33(4):371-376)

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Viewpoint

Should Physical Activity Be Considered Essential During the COVID-19 Pandemic?

Francisco José Gondim Pitanga et al. Carmem Cristina Beck Cristiano Penas Seara Pitanga

Introduction

The novel coronavirus (COVID-19) disease, considered a pandemic by the World Health Organization (WHO), which until April 13, 2020, had 1,776,867 confirmed cases with 111,828 deaths worldwide, led the Ministry of Health of Brazil to prepare a manual with several actions to prevent the spread of the disease. Among these actions, social distancing is recommended, instructing people to remain at home. In addition, many heads of state and municipal executive power across Brazil have issued decrees proposing the closure of several spaces, including gyms, clinics, clubs, and other public and private spaces for physical activity. These actions caused the Brazilian population to have difficulties to continue the practice of physical activity.

On the other hand, since the beginning of the pandemic, some studies have been published in different parts of the world, calling attention to the importance of continuing to practice physical activity. For example, in the city of Wuhan in China, the initial epicenter of the disease, people were recommended to practice physical activity even at home. In a recent study focused on elderly people, outdoor physical activity and also exercising at home were suggested as therapy to combat the physical and mental consequences of quarantine due to the Covid-19 pandemic. In addition, according to a recent position of the American College of Sports Medicine, people should continue to stay physically active while at home during the pandemic.

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Original Article

Evaluation of Polymorphisms in IL8 and IL16 Genes in Patients with Acute Coronary Syndrome

Lílian Caroliny Amorim Silva et al. Romário Martins Araújo Fábia Carla Silva Soares Roberto Pereira Werkhauser … Sergio Tavares Montenegro Tetsuo Tashiro Viviane do Carmo Vasconcelos Carvalho Silvia Maria Lucena Montenegro

Abstract

Background:

Acute coronary syndrome (ACS) is a cardiovascular disease caused by obstruction of coronary arteries by atheromatous plaque. Susceptibility to this disease may be related to genetic variations, such as single nucleotide polymorphisms (SNPs).

Objective:

In this study, we evaluated the relationship between SNPs in IL8 (rs4073; -251 A/T) and IL16 (rs11556218; T/G) genes and SCA in a Brazilian population.

Materials and Methods:

A sample of 200 patients with ACS and 50 non-ACS patients hospitalized at the Real Hospital Português, Recife – PE, Brazil, and 220 blood donors (donors) was used. Genotyping was carried out by polymerase chain reaction, and DNA sequencing. Statistical analyzes were performed using the Williams G, Chi-square and Kruskal Wallis tests, using the BioEstat 5.0 program, and the data with a value of p < 0.05 were considered significant.

Results:

In the IL8 gene, the AT genotype was the most frequent (p > 0.05) in all three groups. In the IL16 gene, genotypic distributions were different between patients with ACS and the donor group (p = 0.002), with the most frequent G allele in the second group (p = 0.0052). The IL-16 cytokine was higher in donors than in patients with ACS (p = 0.04) and the G (TG + GG) allele had higher values of this cytokine (p = 0.01).

Conclusions:

The results demonstrate the important role of the rs11556218 SNP in IL16 gene in SCA, evidencing that the G allele may be associated with a decreased risk of the disease.

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Original Article

Evaluation of Cardiovascular Risk in Hypertensive Individuals Attending a Primary Health Care Center

Tiago Ricardo Moreira et al. Luana Vieira Toledo Érica Toledo Mendonça Renata Maria Colodette … Luciana Saraiva Silva Rosângela Minardi Mitre Cotta

Abstract

Background:

Cardiovascular risk (CVR) stratification has traditionally been used as a strategy for the prevention of cardiovascular diseases in asymptomatic people.

Objective:

To identify the CVR in hypertensive patients attending a primary health care center, using the Framingham risk score, and to evaluate possible associations and correlations with sociodemographic, clinical and laboratory variables not included in this score. This cross-sectional study was conducted with hypertensive patients treated in a primary health care center in Brazil (n = 166).

Methods:

Data collection, administration of questionnaires, anthropometric measurements and laboratory tests were performed from July to August 2013. Multiple linear regression was used in the analysis. A two-tailed p-value < 0.05 was considered significant.

Results:

High CVR was independently associated with male sex (B = 8.73; 95%CI: 6.27: 11.19), high serum levels of total cholesterol (B = 0.05; IC95%: 0.02: 0.08), number of drugs used (B = 0.55; 95%Ci: 0.12: 0.98) and a low glomerular filtration rate (GFR) (B = -0.11; 95%CI: -0.18 : -0.03).

Conclusion:

The results of this study reinforce the importance of continuous and longitudinal care practices directed to hypertensive patients aiming at early detection of risk factors and appropriate intervention to improve the prognosis of this population.

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Original Article

Comparative Analysis of Direct and Indirect Methods for the Determination of Maximal Oxygen Uptake in Sedentary Young Adults

Alfredo Moreira da Rocha Neto et al. Artur Haddad Herdy Pablo de Souza

Abstract

Background:

Maximal oxygen uptake is a powerful prognostic indicator and a reliable measure of physical conditioning. It can be measured directly by cardiopulmonary exercise testing (CPET) or indirectly by formulas derived from conventional protocols.

Objective:

We compared the VO₂ max obtained by formula using exercise testing with Bruce protocol (BP) with the VO₂ max obtained by CPET on the treadmill.

Methods:

We selected 41 healthy, non-obese, physically inactive young volunteers, aged between 21 and 50 years, residents of Florianópolis, Brazil.

Results:

Twenty-one women (52%) with mean age of 35.62 ± 8.83 years, and 20 males, with mean age of 32.5 ± 7.18 years participated in the study. Statistically significant differences were found for VO₂ max between the two methods (BP – 42.31 ± 5.21 ml/kg.min vs. CPET – 30.46 ± 5.50 ml/kg.min., p < 0.0001). The Bruce formula overestimated the result by 34.1% (BP – 45.95 ± 3.94 ml/kg.min vs. CPX – 34.27 ± 4.20 ml/kg.min, p < 0.0001) for men, and by 44.8% (BP – 38.84 ± 3.72 ml/kg.min vs. CPX – 26.83 ± 3.90, p < 0.0001) for women. A moderate correlation was observed between the methods (r = 0.65). When classifying the results according to the table of aerobic capacity of the American Heart Association, the agreement was null (kappa = 0.0034; Pearson chi2 = 0.001).

Conclusion:

VO₂ estimated by BP is not capable of demonstrating the true aerobic capacity in these individuals, while CPET is an important tool for early detection of diminished functional capacity in sedentary young men and women.

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