physical fitness – ABC CARDIOL

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Editorial

Analysis of Cardiopulmonary Exercise Test in Pre- and Post-COVID-19

José Antônio Caldas Teixeira

The SARS-CoV-2 (COVID-19) pandemic that began in December 2019 in the city of Wuhan, Hubei Province, China, quickly became a pandemic affecting over 600 million people, resulting in over 6 million deaths. COVID-19 has been associated with significant mortality and morbidity, including adverse pulmonary and cardiac sequelae.

It is known that COVID-19 symptoms persist beyond the acute phase, leading to post-acute sequelae, known as Long COVID Syndrome, which lasts for more than 60 days or indefinitely. Although the precise mechanisms are not fully elucidated, it is associated with various symptoms, with fatigue and exercise intolerance being the most prevalent.

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Original Article

Activities of Daily Living, Physical Activity, Physical Fitness and Quality of Life in Children with Congenital Heart Disease: A Case-Control Study

Berfin Kişin et al. Sema Savci Buse Ozcan Kahraman Aylin Tanriverdi … Hazer Erçan Bozyer Halise Zeynep Genç Mustafa Kir

Abstract

Background

Despite reports of reduced physical fitness in children with congenital heart disease (CHD), no specific performance evaluations for activities of daily living have been conducted.

Objectives

The aim was to compare the activities of daily living, quality of life, posture, physical fitness and physical activity levels of children with CHD with healthy controls (HC).

Methods

The study included 30 children aged 6-14 diagnosed with moderate or severe CHD and 30 age-sex-matched HC. The sociodemographic and clinical data of the participants were recorded. All participants went through several tests, namely the TGlittre-P test for activities of daily living, the 6-minute walk test (6MWT) for functional capacity, the Fitnessgram test battery for physical fitness, the hand dynamometer for measuring grip strength, the pedometer for measuring physical activity, and both the child and parents reported the Pediatric Quality of Life Inventory (PedsQL) for evaluating the quality of life, in addition to posture analyses. Values of p < 0.05 were considered statistically significant.

Results

Individuals with CHD had a longer TGlittre-P test completion time and a shorter 6MWT distance than HC (TGlittre-P: CHD 3.45 [3.24-4.02]min vs. HC 3.10 [2.57-3.23]min, 6MWT: CHD 514.00 [412.50-566.00]m vs. HC 591.50 [533.00-631.00]m). For the CHD group, sit-ups, push-ups, trunk lift, and sit-and-reach test scores within the Fitnessgram battery, grip strength, posture, and quality of life scores were lower than those for the HC group. Physical activity levels were similar in the groups.

Conclusions

The performance of activities of daily living, functional capacity, physical fitness, posture, and quality of life of children with moderate and severe CHD were affected compared to healthy peers.

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Original Article

High Cardiorespiratory Optimal Point Values Are Related to Cardiovascular Mortality in Men Aged 46 to 70 Years: a Prospective Cohort Study

Claudio Gil Araújo et al. Plínio Santos Ramos Jari A. Laukkanen Jonathan Myers … Setor K. Kunutsor Matthew P. Harber Thijs M. H. Eijsvogels Beatriz D. Marinho Christina Grüne de Souza e Silva

Abstract

Background:

Several hemodynamic and respiratory variables measured during cardiopulmonary exercise testing (CPX) have been shown to predict survival. One such measure is the cardiorespiratory optimal point (COP) that reflects the best possible circulation-respiration interaction, but there are still limited data on its relationship with adverse outcomes.

Objective:

To assess the association between COP and cardiovascular mortality in men aged 46 to 70 years.

Methods:

A sample of 2201 men who had anthropometric, clinical, and COP data obtained during cycling CPX between 1995 and 2022 was extracted from the CLINIMEX Exercise cohort. COP was identified as the minimal minute-to-minute VE/VO₂ during CPX. Vital data were censored on October 31, 2022 for ICD-10-identified cardiovascular deaths. Cox proportional hazard models were used to estimate hazard ratios (HRs) with 95% confidence intervals (95% CIs).

Results:

The mean ± standard deviation age was 57 ± 6 years and the median COP value was 24 (interquartile range = 21.2 to 27.4). During a mean follow-up of 4688 ± 2416 days, 129 (5.6%) patients died from cardiovascular causes. The death rates for low ( 30) categories of COP were 3.2%, 9.6%, and 18.7%, respectively. Following adjustment for age, history of myocardial infarction, diagnosis of coronary artery disease, and diabetes mellitus, the HR (95% CI) for cardiovascular mortality comparing very high versus low COP was 2.76 (1.87 to 4.07; p < 0.001).

Conclusions:

Our data indicate that, for a general population-based sample of men, COP > 30 represents a considerably higher risk for cardiovascular death. Information on COP could assist cardiovascular risk assessment in men.

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Original Article

Blood Pressure in Children: Association with Anthropometric Indicators, Body Composition, Cardiorespiratory Fitness and Physical Activity

Gisele Pinheiro et al. Júlio Mello Adroaldo Gaya Anelise Reis Gaya

Abstract

Background:

Evidence points to anthropometric and fitness variables as associated factors with children’s blood pressure. Analysing these factors in a single context is a relevant possibility of identifying the weight that each factor can present for the development of arterial hypertension.

Objective:

Identify the possible associations between anthropometric measurements, body composition, moderate-vigorous physical activity (MVPA) and cardiorespiratory fitness (CRF) with blood pressure in children.

Methods:

Correlational study with a quantitative approach. Sample: 215 schoolchildren aged 6-12 years selected by convenience criteria of a public school in Porto Alegre, Brazil. Blood pressure was measured with a digital sphygmomanometer. For data treatment, the values of systolic and diastolic blood pressure were standardized (Z score) and added. The variables tested as predictors were: MVPA; body fat percentage (BF%); Body Mass Index (BMI); waist-height ratio (WHTR); maturity-offset and CRF. After checking the normality parameters, the crude and adjusted associations (for sex, age and maturity-offset) were tested with linear regression equations. For the analyses, p <0.05 was considered.

Results:

Three different models indicated the best sets of factors associated with standardized blood pressure. Model 1 (R² = 0.21) consisted of the variables WHTR (β = 9.702) and MVPA (β = −0.021). Model 2 (R² = 0.19) was composed of the variables BMI (β = 0.156) and MVPA (β = −0.021). Model 3 (R² = 0.18) included the variables BF% (β = 0.063) and CRF (β = −0.004).

Conclusion:

Blood pressure in children is predicted by the body variables BF%, BMI and WHTR, in addition, it is negatively associated with MVPA and CRF.

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Editorial

Atrioventricular Conduction System Disorders and Potential Risks of Arrhythmic Events in Endurance Athletes

Carlos Alberto Cordeiro Hossri

Short Editorial related to the article: Assessing Dynamic Atrioventricular Conduction Time to RR-interval Coupling in Athletes and Sedentary Subjects

Some disorders found on electrocardiograms are commonly seen in endurance or high-performance athletes and often have characteristics that are similar to those observed in elderly individuals or in those with cardiovascular disease.^–

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Original Article

Dynamic Balance and Mobility Explain Quality of Life in HFpEF, Outperforming All the Other Physical Fitness Components

Cristine Schmidt et al. Mário Santos Lucimere Bohn Bruno Miguel Delgado … Daniel Moreira-Gonçalves Adelino Leite-Moreira José Oliveira

Abstract

Background

Physical fitness is an important determinant of quality of life (QoL) in heart failure with preserved ejection fraction (HFpEF) patients. However, how the different physical fitness components correlate with the specific dimensions of QoL in HFpEF patients remains unknown.

Objective

To evaluate the association between different physical fitness components and QoL dimensions in HFpEF patients, and, assess which physical fitness components were independently associated to QoL.

Methods

Patients with HFpEF were assessed for physical fitness [dynamic balance and mobility (8-foot-up-and go test), upper body strength (handgrip), cardiorespiratory fitness (CRF) (6-minute-walking test) and body composition (body mass index)] and for QoL (Minnesota Living With Heart Failure Questionnaire). Partial correlation was used to verify the association between physical fitness components and QoL dimensions. The determination of independent predictors in QoL dimensions was assessed through stepwise multivariate linear regression analysis. Statistical significance was set at p<0.05.

Results

Both CRF and dynamic balance and mobility are significantly associated with the total score and physical dimensions of QoL (p<0.05), but only dynamic balance and mobility were concomitantly associated with the emotional dimension (r=0.597; p=0.004). Dynamic balance and mobility were independently associated with total score (β=0.651; r²=0.424; p=0.001), physical (β=0.570; r²=0.324; p=0.04) and emotional (β=0.611; r2=0.373 p=0.002) dimensions of QoL.

Conclusion

Our data suggests that dynamic balance and mobility better assess QoL than CRF, which is commonly measured in clinical practice. Whether interventions specifically targeting dynamic balance and mobility have different impacts on QoL remains unknown. (Arq Bras Cardiol. 2020; 114(4):701-707)

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Original Article

Assessing Dynamic Atrioventricular Conduction Time to RR-interval Coupling in Athletes and Sedentary Subjects

Paulo Roberto Benchimol-Barbosa et al. Olivassé Nasario Junior Jurandir Nadal

Abstract

Background

Atrioventricular conduction time ( AVCT ) is influenced by autonomic input and subject to physiological remodeling.

Objective

To evaluate beat-by-beat AVCT and RR-interval variability in athletes and healthy sedentary subjects.

Methods

Twenty adults, including 10 healthy sedentary (Controls) and 10 elite long-distance runners (Athletes), age, weight and height-adjusted, underwent maximal metabolic equivalent (MET) assessment, and 15-min supine resting ECG recording seven days later. The interval between P-wave and R-wave peaks defined the AVCT . Mean (M) and standard deviation (SD) of consecutive RR-intervals (RR) and coupled AVCT were calculated, as well as regression lines of RR vs. AVCT (RR-AVCT) . Concordant AV conduction was defined as positive RR-AVCT slope and discordant otherwise. A multivariate linear regression model was developed to explain MET based on AVCT and RR-interval variability parameters. Significance-level: 5 %.

Results

In Athletes, M-RR and SD-RR values were higher than in Controls, whereas M-AVCT and SD-AVCT were not. RR-AVCT slopes were, respectively, 0.038 ± 0.022 and 0.0034 ± 0.017 (p < 0.05). Using a cut-off value of 0.0044 (AUC 0.92 ± 0.07; p < 0.001), RR-AVCT slope showed 100% specificity and 80% sensitivity. In a multivariate model, SD-RR and RR-AVCT slope were independent explanatory variables of MET (F-ratio: 17.2; p < 0.001), showing 100% specificity and 90% sensitivity (AUC 0.99 ± 0.02; p < 0.001).

Conclusion

In elite runners, AVCT to RR -interval dynamic coupling shows spontaneous discordant AV conduction, characterized by negative AVCT vs. RR -interval regression line slope. RR -intervals standard deviation and AVCT vs. RR -interval regression line slope are independent explanatory variables of MET (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

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Review Article

Effects of Exercise Training on Cardiovascular and Autonomic Parameters in Stroke Survivors: A Systematic Review

Bruno Bavaresco Gambassi et al. Fabiano de Jesus Furtado Almeida Ana Eugênia Araújo Furtado Almeida João Alberto Ribeiro … Tânia Maria Gaspar Novais Paulo Adriano Schwingel Ciro Oliveira Queiroz Clarcson Plácido Conceição dos Santos Bruno Rodrigues

Abstract

Negative changes in cardiovascular and autonomic variables in stroke survivors have encouraged the global scientific community to focus on investigating therapeutic strategies to mitigate stroke damage. The objective of the present study was to describe the effects of exercise training on cardiovascular and autonomic variables in stroke survivors. We used the PICO (population, intervention, control/comparison, and outcome variables) model for the search of articles in PubMed and Physiotherapy Evidence Databases from 2009 to December 2018. The following data were also recorded: type of study, author, year of publication, participants (time after stroke, sample size, and age) and benefits of exercise training. A total of 544 articles were initially selected, of which nine peer-reviewed articles met the search criteria. These nine studies enrolled 611 participants (middle-aged or elderly), and pointed to positive effects of training on maximal oxygen uptake, peak aerobic capacity, 6-minute walk test and resting heart rate. However, more well-controlled studies are needed to confirm the benefits of exercise training on cardiovascular and autonomic variables in this population.

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Viewpoint

Invasive Coronary Physiological Assessment in Symptomatic Middle-Aged Endurance Athletes

Omar M. Issa et al. J. Sawalla Guseh Ignacio Inglessis Aaron L. Baggish

Abstract

Despite the health benefits of routine exercise, coronary artery disease (CAD) is common among older competitive athletes and is an important cause of sudden cardiac death. Athletes with suspected or confirmed CAD routinely undergo conventional coronary angiography involving the performance of invasive coronary physiological assessment using the fractional flow reserve (FFR) or the instantaneous-wave free ratio (iFR). Data defining the role of invasive coronary physiological assessment, while robust in general clinical populations, are untested among older competitive athletes with CAD. The paper discusses the challenges and uncertainties surrounding the use of the FFR and iFR in this unique population with an emphasis on the need for future work to better define this approach.

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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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Editorial

Non-Pharmacological Treatment of Cardiovascular Disease | Importance of Physical Exercise

Mariana Janini Gomes et al. Luana Urbano Pagan Marina Politi Okoshi

Cardiovascular diseases are currently the major health problem and are directly involved in more than 17 million deaths each year, which represents 50% of all deaths from noncommunicable diseases. In addition to their effects on individual well-being, cardiovascular diseases are responsible for a high economic impact. A recently published study showed that in Brazil, only four diseases – arterial hypertension, myocardial infarction, atrial fibrillation and heart failure – reached an estimated total financial cost of 56.2 billion reais in the year 2015.

The treatment of cardiovascular diseases involves the use of specific drugs and adherence to non-pharmacological interventions. This Editorial will be dedicated to the role of physical exercise in the treatment of cardiovascular diseases.

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Original Article

Talk the talk and walk the walk! Association between Weekly Exercise Load and Knowledge about Recommendations for Fighting Innactivity

Diogo Thadeu Meira et al. Leonardo Giglio Gonçalves Luiz Henrique Araújo Matheus Gasparini … Bernardo Souza Cunha Amanda Monteiro Michele Heringer Christiane Prado Andre Volschan Fabrício Braga da Silva

Abstract

Background:

The World Health Organization (WHO) recommends as a weekly “target dose” of exercise 150 minutes of moderate exercise or 75 minutes of intense exercise. Public health policies have prioritized the practice of exercise as a strategy for disease prevention and health promotion, with health professionals as their main promoters.

Objective:

To assess the interaction between the amount of exercise per week and the knowledge about recommendations for fighting a sedentary lifestyle among health care professionals attending a congress of cardiology.

Methods:

Participants of the 2017 Rio de Janeiro Society of Cardiology Congress were interviewed. Knowledge about the World Health Organization (WHO) recommendations for fighting a sedentary lifestyle was assessed by asking participants the question: “How much weekly exercise is recommended by the WHO?” Responders were stratified by the weekly exercise load reported. A multivariate logistic model was created to determine independent predictors of knowledge.

Results:

A total of 426 participants were interviewed (45.5% men, median age 31 years, 37.8% physicians, 65.8% of the physicians were cardiologists). The overall knowledge level was 44.6%; 38.1%, 52.7% and 56.6% among non-physicians, non-cardiologists and cardiologists, respectively (p = 0.002). Of all participants, 21.8% were inactive, 15% were lightly active, 34.7% moderately active and 28.4% highly active, and the percentage of individuals who gave a correct answer to the question on exercise recommendations was 30.1%, 42%, 48% and 52.9% respectively (p < 0.0001). In the multivariate analysis, being highly active (OR = 2.25, IC95%, 1.238 – 4.089), moderately active (OR = 1.93, IC 95% 1.105 – 3.39) and being a cardiologist (OR = 2.01, IC 95% 1.243 – 3,267) were predictors of knowledge.

Conclusions:

There was a linear association between exercise level and knowledge about the WHO recommendations on exercise. Policies to stimulate the practice of exercise among health professionals can positively impact campaigns for reducing sedentary lifestyle in the general population.

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Editorial

Physical Inactivity in Brazil and Sweden – Different Countries, Similar Problem

Ricardo Stein et al. Mats Börjesson

Does Sweden and Brazil have the same problem?

Low or decreasing PA levels often correspond with a high or rising gross national product. In high-income countries, 26% of men and 35% of women were insufficiently physically active, as compared to 12% of men and 24% of women in low-income countries. This drop is partly due to inactivity during leisure time and sedentary behavior at home or during work. Also, an increase in car, bus and train use has contributed to insufficient PA. Besides, fear of violence and crime in outdoor areas, pollution, high-density traffic, lack of parks, sidewalks and sports/recreation facilities discourage people from becoming more active.

There is a known socioeconomic division regarding PA levels in Europe; the Eurobarometer (), a survey series based on self-reported activity levels and sports participation, shows that 91% of Swedes of all ages, but only 22% of Bulgarians report to exercise. Populations from highly industrialized countries from northern and western Europe tend to practice more exercise/sports activities, compared with southeastern European countries. This, somehow, illustrates the well-known socioeconomic difference, in which higher education is associated with more sitting time, but also more “gym-cards” and higher fitness, typical of northern Europe, in contrast with other European countries.

[…]

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Editorial

CADE-Q SV: Practical and Relevant in the Assessment of Patients with Cardiovascular Diseases regarding their Health Condition

Juliana Beust de Lima

Cardiovascular diseases (CVD) remain the leading cause of death worldwide. According to estimates by the World Health Organization (WHO), approximately 17.9 million individuals die per year due to this clinical condition. In Brazil, a registry of the Brazilian Society of Cardiology shows an increase in mortality over the years, affecting 383,961 individuals in 2017.

Considering the strong association of CVD with morbidity and mortality, as well as the impairment of functional capacity and quality of life shown by these patients, strategies aimed at minimizing these impairments and that can be shown to be cost-effective should be implemented. In this scenario, cardiovascular rehabilitation (CVR) is crucial and should be part of the overall treatment of CVD.

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IJCS

Original Article

Correlation Between Physical Activity and Clinical Variables in Patients with Acute Myocardial Infarction

Ana Teresa Glaser Carvalho et al. Thays Fraga Duarte Andressa Sarda Maiochi Roberto Leo da Silva … Tammuz Fattah Daniel Medeiros Moreira

Abstract

Background:

Physical activity reduces the risk of coronary heart disease, one of the leading causes of death in the world.

Objectives:

This study intends to correlate physical activity and clinical variables of the patients hospitalized in public hospitals of Santa Catarina after the first acute myocardial infarction.

Methods:

The selected patients answered a questionnaire on different clinical variables. Physical activity was measured using the Baecke’s questionnaire. Data were tabulated and analyzed using the SPSS 13.0 for Windows software. Normality was assessed using the Kolmogorov-Smirnov test. Correlations between two quantitative variables were evaluated by Pearson’s correlation. Values of p < 0.05 were considered statistically significant.

Results:

The study showed a weak positive correlation between the Baecke score and years of schooling (r = 0.361; p = 0.001). There was a weak negative correlation between the Baecke score and the PHQ9 depression score (r = -0.252; p = 0.009). The study also showed a weak negative correlation between the PHQ9 depression score and the Mini Mental score (r = -0.258; p = 0.007), as well as a weak negative correlation between PHQ9 and schooling years with (r = -0.199, p = 0.039).

Conclusions:

There is a positive correlation between physical activity and years of schooling in hospitalized patients with first acute myocardial infarction. Negative correlations were found between physical activity and depression, between depression and the Mini-Mental State Examination, and between depression and years of schooling in these patients.

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Original Article

Effects of Continuous and Accumulated Exercise on Endothelial Function in Rat Aorta

Juliana Edwiges Martinez et al. Elane de Fátima Taipeiro Agnaldo Bruno Chies

Abstract

Background:

The practice of exercise in short bouts repeated throughout the day may be an alternative strategy to lift people out of physical inactivity.

Objective:

to evaluate if accumulated exercise, as occurs in continuous exercise training, improve endothelial function in rat aorta.

Methods:

Wistar male rats were divided into three groups: continuous exercise (CEx, 1 hour on the treadmill) or accumulated exercise (AEx, 4 bouts of 15 minutes / day) for 5 days/week for 8 weeks, or sedentary (SED). During the training period, body weight gain and increase in exercise performance were recorded. On sacrifice day, aorta was dissected into rings (3-5 mm) and mounted on the organ bath.

Results:

Fitness was significantly greater in CEx and AEx rats as compared with SED animals. In addition, compared with the SED group, CEx animals had a lower body mass gain, and the aorta obtained from these animals had reduced contractile response to norepinephrine and greater acetylcholine-induced relaxation. These results were not observed in ACEx animals.

Conclusions:

Both CEx and AEx improved fitness, but only CEx led to reduced body weight gain and improved endothelial function.

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IJCS

Brief Communication

Exercise Improves Cardiovascular Risk Factors, Fitness, and Quality Of Life in Hiv+ Children and Adolescents: Pilot Study

Luiz Rodrigo Augustemak de Lima et al. Isabela de Carlos Back Carmem Cristina Beck Bruno Caramelli

Abstract

Children and adolescents infected by HIV through mother-to-child transmission are at high risk of developing premature cardiovascular diseases due to dyslipidemia, insulin resistance and low-grade chronic inflammation. The aim of the pilot study was to verify the effect of a playful exercise program on cardiovascular, morphological, metabolic, fitness, and quality of life outcomes. A non-randomized clinical trial consisting of 24 sessions of playful aerobic and resistive exercises was applied to 10 children and adolescents living with HIV from Florianopolis, Brazil. The following variables were obtained before and after the program: fasting total cholesterol, HDL-c, LDL-c, triglycerides, glucose, C-reactive protein, blood pressure, common carotid artery intima-media thickness (CCA-IMT), flexibility, muscular endurance, aerobic fitness, anthropometry, and measured quality of life. After the intervention, a decrease in systolic blood pressure (-6.8 mmHg, 6.6%; p = 0.019) and CCA-IMT (-60.0 µm, 12.2%; p = 0.002) was observed after 24 sessions. There was an increase in upper-limb muscular endurance (+3.3 rep.min^-1, 63.5%; p = 0.002), flexibility (+5.7 cm, 26.0%; p = 0.001), and quality of life (+10.4 points, 27.5%; p = 0.003). In our sample of children and adolescents living with HIV, a short-term exercise program was associated with improvement in cardiovascular risk, fitness, and quality of life.

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Original Article

Dyslipidemia is Associated with Unfit and Overweight-Obese Children and Adolescents

Cézane Priscila Reuter et al. Priscila Tatiana da Silva Jane Dagmar Pollo Renner Elza Daniel de Mello … Andréia Rosane de Moura Valim Luiza Pasa Rafaela da Silva Miria Suzana Burgos

Abstract

Background:

Both poor aerobic fitness and obesity, separately, are associated with abnormal lipid profiles.

Objective:

To identify possible relationships of dyslipidemia with cardiorespiratory fitness and obesity, evaluated together, in children and adolescents.

Methods:

This cross-sectional study included 1,243 children and adolescents (563 males and 680 females) between 7 and 17 years of age from 19 schools. Obesity was assessed using body mass index (BMI) measurements, and cardiorespiratory fitness was determined via a 9-minute run/walk test. To analyze the lipid profile of each subject, the following markers were used: total cholesterol, cholesterol fractions (high-density lipoprotein and low-density lipoprotein) and triglycerides. Data were analyzed using SPSS v. 20.0, via prevalence ratio (PR), using the Poisson regression.

Results:

Dyslipidemia is more prevalent among unfit/overweight-obese children and adolescents compared with fit/underweight-normal weight boys (PR: 1.25; p = 0.007) and girls (PR: 1.30, p = 0.001).

Conclusions:

The prevalence of dyslipidemia is directly related to both obesity and lower levels of cardiorespiratory fitness.

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Artigo Original

Cardiorespiratory fitness of a Brazilian regional sample distributed in different tables

Karlyse Claudino Belli et al. Carine Calegaro Cleusa Maria Richter Jonatas Zeni Klafke … Ricardo Stein Paulo Ricardo Nazario Viecili

BACKGROUND: Most classification tables of cardiorespiratory fitness (CRF) used in clinical practice are international and have not been validated for the Brazilian population. That can result in important discrepancies when that classification is extrapolated to our population. OBJECTIVE: To assess the use of major CRF tables available in a Brazilian population sample of the Central High Plan of the state of Rio Grande do Sul (RS). METHODS: This study assessed the retrospective data of 2,930 individuals, living in 36 cities of the Central High Plan of the state of RS, and considered the following: presence of risk factors for cardiovascular disease and estimated maximum oxygen consumption (VO2peak) values obtained through exercise test with Bruce protocol. To classify CRF, the individuals were distributed according to sex, inserted in their respective age groups in the Cooper, American Heart Association (AHA) and Universidade Federal de São Paulo (Unifesp) tables, and classified according to their VO2peak. RESULTS: Women had lower VO2peak values as compared with those of men (23.5 ± 8.5 vs. 31.7 ± 10.8 mL.kg-1.min-1, p < 0.001). Considering both sexes, VO2peak showed an inverse and moderate correlation with age (R = -0.48, p < 0.001). An important discrepancy in the CRF classification levels was observed between the tables, ranging from 49% (Cooper x AHA) to 75% (Unifesp x AHA). CONCLUSION: Our findings indicate important discrepancy in the CRF classification levels of the tables assessed. Future studies could assess whether international tables could be used for the Brazilian population and populations of different regions of Brazil.

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Artigo Original

Effects of age and aerobic fitness on heart rate recovery in adult men

Gabriela Alves Trevizani et al. Paulo Roberto Benchimol-Barbosa Jurandir Nadal

BACKGROUND: Physiological aging leads to cardiac autonomic dysfunction, which is associated with the onset and worsening of cardiovascular disease and an increased risk of death. Currently, physical exercise is considered a cardioprotective strategy and more research is needed on its benefit on cardiac autonomic function. OBJECTIVE: To evaluate the autonomic control of heart rate in healthy young and middle-aged volunteers with different levels of aerobic fitness. METHODS: The study included 68 volunteers, stratified for age and level of aerobic fitness. Based on aerobic fitness assessed by the submaximal exercise test, subjects were separated into two groups, good fitness and poor fitness. Assessment of cardiac autonomic control was performed based on measurements of heart rate variability at rest and heart rate recovery post-exercise. Analysis of variance with two factors was used to compare the variables investigated. RESULTS: The heart rate variability is significantly lower in middle-aged volunteers than in young individuals, regardless of the aerobic fitness level (p <0.01). Higher levels of aerobic fitness in middle-aged volunteers are associated with earlier post-effort vagal reentry – rate of HR decline after 1min30s: 39.6% good aerobic fitness vs. poor 28.4% (p < 0.01). CONCLUSION: Better levels of aerobic fitness act beneficially on the autonomic control of post-exercise heart rate, preserving the vagal reentry velocity in healthy middle-aged volunteers. However, it does not attenuate the decrease in heart rate variability due to the natural aging process.

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Artigo Original

Validity and equivalence of the Portuguese version of the Veterans Specific Activity Questionnaire

Geraldo de Albuquerque Maranhão-Neto et al. Antonio Carlos Ponce de Leon Paulo de Tarso Veras Farinatti

BACKGROUND: The Veterans Specific Activity Questionnaire (VSAQ) has been used to individualize exercise testing (ET) and to indirectly assess cardiorespiratory fitness (CRF) in epidemiological studies. Nevertheless, there is no validated Portuguese version. OBJECTIVE: To verify the criterion-related validity and the measurement equivalence of a Portuguese version of VSAQ in 95 individuals, 8 women (aged 69 ± 7 years) referred to ET. METHODS: The subjects performed a cardiopulmonary test with incremental to maximal exercise on a cycle ergometer. The correlation between VSAQ score and Maximum Measured and Estimated METs was compared to results from other studies. The VSAQ Nomogram was calculated and its results were compared to CRF real values by linear regression. Limits of concordance and mean differences (biases) were assessed according to the Bland Altman methodology. RESULTS: The VSAQ scores were significantly correlated to the Measured METs (r = 0.64) and Estimated METs (r = 0.67), results that were equivalent to those obtained by the original versions. The VSAQ Nomogram presented multiple R of 0.78 (Measured MET) and 0.80 (Estimated MET). However, the Nomogram seems to have underestimated CRF values greater than 6 METs. CONCLUSION: The VSAQ version confirmed its validity and equivalence to the original version, especially when evaluating individuals with coronary heart disease and older adults.

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Artigo Original

Influence of nutritional status and VO2max on adiponectin levels in men older than 35 years

Eduardo Camillo Martinez et al. Macos de Sá Rego Fortes Luiz Antônio dos Anjos

BACKGROUND: Adiponectin is considered an important factor in the pathogenesis of cardiovascular and metabolic diseases, due to its anti- atherogenic and anti-inflammatory properties. Few studies, however, have suggested the existence of a direct association between adiponectin levels and cardiorespiratory fitness and physical activity levels. OBJECTIVE: To verify the influence of the nutritional status and cardiorespiratory fitness on plasma adiponectin levels in adult men. METHODS: A total of 250 subjects, all in active duty in the Brazilian Army (BA), with a mean age of 42,6 ± 4,8 years volunteered to participate in the study. Plasma levels of adiponectin were measured, as well as body mass, height, waist circumference (WC), fat percentage by hydrostatic weighing and VO2max by ergospirometry. A questionnaire was used to obtain the characteristics of the physical training performed by the individuals. RESULTS: The sample showed that 121 (48%) individuals were overweight and 36 (14%) were obese. Moreover, 66 individuals (27%) had a body fat percentage > 25% and 26,7% had a WC > 94 cm. Overweight and obese individuals had significantly lower adiponectin levels than those with an adequate nutritional status. Individuals at the highest tertile of VO2max had higher adiponectin levels than the others. The adiponectin levels were positively correlated with the total weekly physical training time and VO2max and inversely correlated with body mass, BMI and WC. The correlation between adiponectin levels and VO2max did not remain significant after being adjusted for BMI and WC. CONCLUSION: Individuals with better cardiorespiratory fitness and normal nutritional status seem to present healthier levels of adiponectin.

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Artigo Original

Evaluation of cardiopulmonary fitness in individuals with hemiparesis after cerebrovascular accident

Angélica Cristiane Ovando et al. Stella Maris Michaelsen Tales de Carvalho Vanessa Herber

BACKGROUND: Due to the hemiparesis, the assessment of cardiorespiratory fitness on individuals after cerebrovascular accident (CVA), using exercise tests with conventional protocols, has become a challenge. OBJECTIVE: Perform cardiopulmonary test (CPT) in hemiparetic patients to a pre-participation evaluation aimed at a careful prescription of aerobic exercise. METHODS: The study included eight individuals with chronic hemiparesis who underwent CPT performed with individualized ramp protocol, developed from information on the gait speed of individuals previously evaluated in the track test. We considered the proposal of inclination ranging from 0 to 10.0%, initial speed corresponding to 70.0% of comfortable walking speed rhythm and 40.0% higher than the maximum speed on the track test, expecting that the CPT with this gradual and steady increase in intensity, lasted from 6 to 8 minutes. RESULTS: In 100.0% of the sample, the reason for discontinuation was peripheral fatigue. The peak VO2 achieved was 20.6 ± 5.7 ml/kg.min. The threshold I was identified in all tests, standing at 82.64 ± 4.78% of peak HR and 73.31 ± 4.97% of peak VO2. The respiratory quotient (R) of the group was 0.96 ± 0.09, and three out of eight individuals (37.5%) reached R higher than 1.00, and the Threshold II was identified in these individuals. We found positive relationships between CPT variables and balance scores, performance in the 6-minute walking test and running speed on the ground. CONCLUSION: The test proved to be useful for prescribing physical activity in these individuals.

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Case Report

Use of 6-minute walk test in pulmonary hypertension management

Elize Fumagalli et al. Maria ângela de Oliveira Ribeiro Mariana Simões Ferreira Camila Isabel da Silva Santos

The 6-minute walk test (T6) is used to assess cardiopulmonary diseases due to its prognosis capacity, easy performance and reproducibility. Pulmonary hypertension (PH) is defined and classified as a hemodynamic consequence leading to increased pulmonary arterial pressure and may result in right ventricular failure and consequent death. This case reports the prescription of T6 by the cardiology team at a university hospital as a means of physical control of a patient with HP, after the introduction and initiation of therapy.

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