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  <front>
    <journal-meta>
      <journal-id journal-id-type="publisher-id">abc</journal-id>
      <journal-title-group>
        <journal-title>Arquivos Brasileiros de Cardiologia</journal-title>
        <abbrev-journal-title abbrev-type="publisher">Arq. Bras. Cardiol.</abbrev-journal-title>
      </journal-title-group>
      <issn pub-type="ppub">0066-782X</issn>
      <issn pub-type="epub">1678-4170</issn>
      <publisher>
        <publisher-name>Sociedade Brasileira de Cardiologia - SBC</publisher-name>
        <publisher-loc>S&#227;o Paulo, SP, Brazil</publisher-loc>
      </publisher>
    </journal-meta>
    <article-meta>
      <article-id pub-id-type="publisher-id" specific-use="scielo-v3">dJ7rVKVzCkd6H3Fk9dPNc3n</article-id>
      <article-id pub-id-type="other">00011</article-id>
      <article-id pub-id-type="publisher-id" specific-use="scielo-v2">S0066-782X2011000600011</article-id>
      <article-id pub-id-type="publisher-id" specific-use="scielo-v1">S0066-782X(11)09600611</article-id>
      <article-id pub-id-type="doi">10.1590/S0066-782X2011005000043</article-id>
      <article-categories>
        <subj-group subj-group-type="heading">
          <subject>Artigos Originais</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Efeito agudo da intensidade do exerc&#237;cio de for&#231;a na modula&#231;&#227;o auton&#244;mica card&#237;aca p&#243;s-exerc&#237;cio</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <name>
            <surname>Lima</surname>
            <given-names>Alu&#237;sio Henrique Rodrigues de Andrade</given-names>
          </name>
          <xref ref-type="aff" rid="aff01"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Forjaz</surname>
            <given-names>Cl&#225;udia L&#250;cia de Moraes</given-names>
          </name>
          <xref ref-type="aff" rid="aff02"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Silva</surname>
            <given-names>Gleyson Queiroz de Moraes</given-names>
          </name>
          <xref ref-type="aff" rid="aff01"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Men&#234;ses</surname>
            <given-names>Annelise Lins</given-names>
          </name>
          <xref ref-type="aff" rid="aff01"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Silva</surname>
            <given-names>Anderson Jos&#233; Melo Rodrigues</given-names>
          </name>
          <xref ref-type="aff" rid="aff01"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Ritti-Dias</surname>
            <given-names>Raphael Mendes</given-names>
          </name>
          <xref ref-type="aff" rid="aff01"/>
        </contrib>
      </contrib-group>
      <aff id="aff01">
        <addr-line>
          <named-content content-type="city">Recife</named-content>
          <named-content content-type="state">Pernambuco</named-content>
        </addr-line>
        <institution content-type="orgname">Universidade de Pernambuco</institution>
        <institution content-type="orgdiv1">Escola Superior de Educa&#231;&#227;o F&#237;sica </institution>
        <country country="BR">Brazil</country>
      </aff>
      <aff id="aff02">
        <addr-line>
          <named-content content-type="city">S&#227;o Paulo</named-content>
          <named-content content-type="state">S&#227;o Paulo</named-content>
        </addr-line>
        <institution content-type="orgname">Universidade de S&#227;o Paulo</institution>
        <institution content-type="orgdiv1">Escola de Educa&#231;&#227;o F&#237;sica e Esportes </institution>
        <country country="BR">Brazil</country>
      </aff>
      <pub-date date-type="collection" publication-format="electronic">
        <month>06</month>
        <year>2011</year>
      </pub-date>
      <volume>96</volume>
      <issue>6</issue>
      <fpage>498</fpage>
      <lpage>503</lpage>
      <history>
        <date date-type="rev-recd">
          <day>03</day>
          <month>11</month>
          <year>2010</year>
        </date>
        <date date-type="received">
          <day>04</day>
          <month>09</month>
          <year>2010</year>
        </date>
        <date date-type="accepted">
          <day>25</day>
          <month>11</month>
          <year>2010</year>
        </date>
      </history>
      <permissions>
        <license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/4.0/" xml:lang="en">
          <license-p>This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.</license-p>
        </license>
      </permissions>
      <abstract>
        <p>FUNDAMENTO: O balan&#231;o simpatovagal card&#237;aco se altera ap&#243;s o exerc&#237;cio de for&#231;a. Contudo, o impacto das caracter&#237;sticas do treinamento de for&#231;a nessa resposta ainda n&#227;o est&#225; claro. OBJETIVO: Analisar o efeito agudo da intensidade do exerc&#237;cio de for&#231;a para tronco e membros superiores na modula&#231;&#227;o auton&#244;mica card&#237;aca p&#243;s-exerc&#237;cio. M&#201;TODOS: Quinze homens jovens realizaram tr&#234;s sess&#245;es experimentais em ordem aleat&#243;ria: controle (C), exerc&#237;cio de for&#231;a com 50% de 1-RM (E50%) e exerc&#237;cio de for&#231;a com 70% de 1-RM (E70%). As sess&#245;es inclu&#237;ram 05 exerc&#237;cios para tronco e membro superior, realizados em tr&#234;s s&#233;ries de 12, 9 e 6 repeti&#231;&#245;es, respectivamente. Antes e aos 20 e 50 minutos ap&#243;s as interven&#231;&#245;es, a frequ&#234;ncia card&#237;aca foi medida para posterior an&#225;lise espectral da sua variabilidade. RESULTADOS: Em compara&#231;&#227;o aos valores anteriores &#224; interven&#231;&#227;o, o intervalo RR e a banda de alta frequ&#234;ncia (AF) aumentaram (maiores altera&#231;&#245;es: + 112 &#177; 83 ms; +10 &#177; 11 un, respectivamente, p &lt; 0,01), enquanto que a banda de baixa frequ&#234;ncia (BF) e a raz&#227;o BF/AF diminu&#237;ram (maiores altera&#231;&#245;es: -10 &#177; 11 un; -2 &#177; 2, respectivamente, p &lt; 0,01) ap&#243;s a sess&#227;o C. Nenhuma dessas vari&#225;veis se alterou significantemente ap&#243;s a sess&#227;o E50% (p &gt; 0,05). Em compara&#231;&#227;o aos valores pr&#233;-exerc&#237;cio, o intervalo RR e a banda AF diminu&#237;ram (maiores altera&#231;&#245;es: -69 &#177; 105 ms; -13 &#177; 14 un, respectivamente, p &lt; 0,01), enquanto que a banda BF e a raz&#227;o BF/AF aumentaram (maiores altera&#231;&#245;es: -13 &#177; 14 un, +13 &#177; 14 un e +3 &#177; 3 un, respectivamente, p &lt; 0,01) ap&#243;s a E70%. CONCLUS&#195;O: A maior intensidade de exerc&#237;cio de for&#231;a para tronco e membros superiores promoveu, agudamente, maior aumento do balan&#231;o simpatovagal card&#237;aco p&#243;s-exerc&#237;cio.</p>
      </abstract>
      <kwd-group xml:lang="pt" kwd-group-type="author-generated">
        <kwd>Exerc&#237;cio</kwd>
        <kwd>esfor&#231;o f&#237;sico</kwd>
        <kwd>sistema nervoso aut&#244;nomo</kwd>
        <kwd>sistema nervoso simp&#225;tico</kwd>
      </kwd-group>
      <pub-date publication-format="electronic" date-type="pub">
        <day>15</day>
        <month>04</month>
        <year>2011</year>
      </pub-date>
    </article-meta>
  </front>
  <body>
    <p>Efeito agudo da intensidade do exerc&#237;cio de for&#231;a na modula&#231;&#227;o auton&#244;mica card&#237;aca p&#243;s-exerc&#237;cio</p>
    <p>
      <bold>Alu&#237;sio Henrique Rodrigues de Andrade Lima<sup>I</sup>; Cl&#225;udia L&#250;cia de Moraes Forjaz<sup>II</sup>; Gleyson Queiroz de Moraes Silva<sup>I</sup>; Annelise Lins Men&#234;ses<sup>I</sup>; Anderson Jos&#233; Melo Rodrigues Silva<sup>I</sup>; Raphael Mendes Ritti-Dias<sup>I</sup></bold>
    </p>
    <p><sup>I</sup>Escola Superior de Educa&#231;&#227;o F&#237;sica - Universidade de Pernambuco, Recife, PE </p>
    <p><sup>II</sup>Escola de Educa&#231;&#227;o F&#237;sica e Esportes - Universidade de S&#227;o Paulo, S&#227;o Paulo, SP - Brasil</p>
    <p>
      <xref ref-type="corresp" rid="end">Correspond&#234;ncia</xref>
    </p>
    <p>
      <bold>RESUMO</bold>
    </p>
    <p><bold>FUNDAMENTO:</bold> O balan&#231;o simpatovagal card&#237;aco se altera ap&#243;s o exerc&#237;cio de for&#231;a. Contudo, o impacto das caracter&#237;sticas do treinamento de for&#231;a nessa resposta ainda n&#227;o est&#225; claro. </p>
    <p><bold>OBJETIVO:</bold> Analisar o efeito agudo da intensidade do exerc&#237;cio de for&#231;a para tronco e membros superiores na modula&#231;&#227;o auton&#244;mica card&#237;aca p&#243;s-exerc&#237;cio. </p>
    <p><bold>M&#201;TODOS:</bold> Quinze homens jovens realizaram tr&#234;s sess&#245;es experimentais em ordem aleat&#243;ria: controle (C), exerc&#237;cio de for&#231;a com 50% de 1-RM (E50%) e exerc&#237;cio de for&#231;a com 70% de 1-RM (E70%). As sess&#245;es inclu&#237;ram 05 exerc&#237;cios para tronco e membro superior, realizados em tr&#234;s s&#233;ries de 12, 9 e 6 repeti&#231;&#245;es, respectivamente. Antes e aos 20 e 50 minutos ap&#243;s as interven&#231;&#245;es, a frequ&#234;ncia card&#237;aca foi medida para posterior an&#225;lise espectral da sua variabilidade. </p>
    <p><bold>RESULTADOS:</bold> Em compara&#231;&#227;o aos valores anteriores &#224; interven&#231;&#227;o, o intervalo RR e a banda de alta frequ&#234;ncia (AF) aumentaram (maiores altera&#231;&#245;es: + 112 &#177; 83 ms; +10 &#177; 11 un, respectivamente, p &lt; 0,01), enquanto que a banda de baixa frequ&#234;ncia (BF) e a raz&#227;o BF/AF diminu&#237;ram (maiores altera&#231;&#245;es: -10 &#177; 11 un; -2 &#177; 2, respectivamente, p &lt; 0,01) ap&#243;s a sess&#227;o C. Nenhuma dessas vari&#225;veis se alterou significantemente ap&#243;s a sess&#227;o E50% (p &gt; 0,05). Em compara&#231;&#227;o aos valores pr&#233;-exerc&#237;cio, o intervalo RR e a banda AF diminu&#237;ram (maiores altera&#231;&#245;es: -69 &#177; 105 ms; -13 &#177; 14 un, respectivamente, p &lt; 0,01), enquanto que a banda BF e a raz&#227;o BF/AF aumentaram (maiores altera&#231;&#245;es: -13 &#177; 14 un, +13 &#177; 14 un e +3 &#177; 3 un, respectivamente, p &lt; 0,01) ap&#243;s a E70%. </p>
    <p><bold>CONCLUS&#195;O:</bold> A maior intensidade de exerc&#237;cio de for&#231;a para tronco e membros superiores promoveu, agudamente, maior aumento do balan&#231;o simpatovagal card&#237;aco p&#243;s-exerc&#237;cio.</p>
    <p><bold>Palavras-chave:</bold> Exerc&#237;cio, esfor&#231;o f&#237;sico, sistema nervoso aut&#244;nomo, sistema nervoso simp&#225;tico.</p>
    <p>
      <bold>Introdu&#231;&#227;o</bold>
    </p>
    <p>O exerc&#237;cio de for&#231;a &#233; recomendado para indiv&#237;duos saud&#225;veis<sup>1,2 </sup>e com cardiopatias<sup>3</sup> devido a seus benef&#237;cios sobre a aptid&#227;o f&#237;sica<sup>4</sup>, sa&#250;de<sup>4</sup> e qualidade vida<sup>5</sup>. Entretanto, ap&#243;s a realiza&#231;&#227;o do exerc&#237;cio de for&#231;a, a modula&#231;&#227;o simp&#225;tica card&#237;aca permanece elevada, enquanto que a modula&#231;&#227;o parassimp&#225;tica mant&#233;m-se reduzida<sup>6-8</sup>, o que pode aumentar o risco de ocorr&#234;ncia de eventos cardiovasculares agudos<sup>9,10</sup>. </p>
    <p>Institui&#231;&#245;es de sa&#250;de, como o <italic>American College of Sports Medicine,</italic> recomendam que o programa de treinamento de for&#231;a seja dividido em duas sess&#245;es: uma com exerc&#237;cios para os membros inferiores e outra com exerc&#237;cios para os membros superiores<sup>11</sup>. Um estudo recente<sup>12</sup> mostrou que realizar exerc&#237;cios apenas para os membros inferiores promove aumento do balan&#231;o simpatovagal card&#237;aco p&#243;s-exerc&#237;cio. Todavia, o impacto da realiza&#231;&#227;o de exerc&#237;cios para tronco e membros superiores nessas respostas ainda n&#227;o foram estudadas. Como a resposta cardiovascular ao exerc&#237;cio de for&#231;a &#233; dependente da quantidade de massa muscular envolvida<sup>13</sup>, &#233; poss&#237;vel que as respostas auton&#244;micas ap&#243;s o exerc&#237;cio de tronco e membros superiores sejam diferentes, o que precisa ser analisado.</p>
    <p>Outro aspecto importante diz respeito &#224; sobrecarga durante o exerc&#237;cio de for&#231;a. Em estudo anterior<sup>6</sup>, foi evidenciado que dois protocolos de exerc&#237;cio de for&#231;a (10 repeti&#231;&#245;es em 80% de 1RM e 20 repeti&#231;&#245;es em 40% de 1RM) promovem altera&#231;&#245;es similares na modula&#231;&#227;o auton&#244;mica card&#237;aca. Todavia, como os protocolos diferiam tanto no volume (n&#250;mero de repeti&#231;&#245;es) como na intensidade (sobrecarga), n&#227;o foi poss&#237;vel estabelecer claramente o impacto isolado da intensidade do exerc&#237;cio na modula&#231;&#227;o auton&#244;mica card&#237;aca p&#243;s-exerc&#237;cio. Como a intensidade do exerc&#237;cio de for&#231;a afeta as respostas metab&#243;licas e mec&#226;nicas na vasculatura, e consequentemente, nos mecanismos reflexos de controle cardiovascular, &#233; poss&#237;vel que diferentes intensidades do exerc&#237;cio de for&#231;a promovam diferentes respostas na modula&#231;&#227;o auton&#244;mica card&#237;aca p&#243;s-exerc&#237;cio.</p>
    <p>Dessa forma, o objetivo deste estudo foi analisar o efeito agudo da intensidade do exerc&#237;cio de for&#231;a para tronco e membro superiores na modula&#231;&#227;o auton&#244;mica card&#237;aca p&#243;s-exerc&#237;cio. Nossa hip&#243;tese &#233; de que o balan&#231;o simpatovagal aumentar&#225; ap&#243;s o exerc&#237;cio de for&#231;a independentemente da intensidade utilizada, por&#233;m uma maior magnitude e uma maior dura&#231;&#227;o dessa resposta ser&#227;o observadas ap&#243;s a sess&#227;o de exerc&#237;cio com maior intensidade.</p>
    <p>
      <bold>M&#233;todos</bold>
    </p>
    <p>
      <bold>Amostra</bold>
    </p>
    <p>Fizeram parte da amostra 15 homens, com idade entre 18 e 25 anos, recrutados na universidade e comunidades locais. Antes de entrarem no estudo, os sujeitos foram esclarecidos sobre todos os procedimentos a que seriam submetidos e, aqueles que concordaram em participar, assinaram o termo de consentimento livre e esclarecido. Este estudo foi aprovado pelo Comit&#234; de &#201;tica em Pesquisa da institui&#231;&#227;o dos autores (223/08). Como crit&#233;rios de inclus&#227;o ao estudo, os indiv&#237;duos deveriam ser eutr&#243;ficos, n&#227;o apresentarem qualquer doen&#231;a cardiovascular, n&#227;o estarem em uso de medica&#231;&#227;o e, nos 06 meses antes do estudo, n&#227;o serem praticantes de qualquer tipo de exerc&#237;cio f&#237;sico.</p>
    <p>
      <bold>Dados cl&#237;nicos</bold>
    </p>
    <p>Para a obten&#231;&#227;o dos dados cl&#237;nicos dos indiv&#237;duos, foi feita anamnese que englobava quest&#245;es sobre os fatores de risco cardiovasculares. Em posse dos dados, os indiv&#237;duos foram estratificados com rela&#231;&#227;o ao risco cardiovascular em alto, moderado ou baixo<sup>1</sup>. </p>
    <p>Al&#233;m da anamnese, medidas antropom&#233;tricas e da press&#227;o arterial foram realizadas. A massa corporal e a estatura foram medidas utilizando uma balan&#231;a digital com precis&#227;o de 0,1 kg (Filizola, Brasil) e um estadi&#244;metro de madeira com precis&#227;o de 0,1 cm, respectivamente. A press&#227;o arterial foi medida pelo m&#233;todo auscultat&#243;rio com os volunt&#225;rios sentados e em repouso, tr&#234;s vezes consecutivas, ap&#243;s 05 minutos de repouso, em duas visitas distintas<sup>14</sup>. Para permanecerem no estudo, os indiv&#237;duos deveriam ser normotensos e apresentar press&#227;o arterial sist&#243;lica igual ou inferior a 120 mmHg e diast&#243;lica igual ou inferior a 80 mmHg<sup>14</sup>. Esse n&#237;vel de press&#227;o arterial foi escolhido porque sujeitos com valores acima desses j&#225; possuem altera&#231;&#245;es no balan&#231;o simpatovagal card&#237;aco<sup>15</sup>.</p>
    <p>As caracter&#237;sticas cl&#237;nicas dos sujeitos est&#227;o presentes na <xref ref-type="table" rid="tab01">Tabela 1</xref>.</p>
    <table-wrap id="tab01">
      <graphic xlink:href="1678-4170-abc-96-06-0498-00043-gt01.jpg"/></table-wrap>
    <p>
      <bold>Sess&#245;es de adapta&#231;&#227;o e teste de uma repeti&#231;&#227;o m&#225;xima (1-RM)</bold>
    </p>
    <p>Antes das sess&#245;es experimentais, cada indiv&#237;duo participou de duas sess&#245;es de adapta&#231;&#227;o aos exerc&#237;cios de for&#231;a, realizadas em dias distintos. Em cada sess&#227;o de adapta&#231;&#227;o, os indiv&#237;duos realizaram tr&#234;s s&#233;ries de 12 repeti&#231;&#245;es com a carga m&#237;nima permitida nos seguintes exerc&#237;cios: i) supino reto, ii) remada curvada, iii) eleva&#231;&#227;o frontal, iv) rosca direta e v) tr&#237;ceps testa. Todos os exerc&#237;cios inclu&#237;dos no estudo foram realizados com pesos livres. </p>
    <p>Dois dias ap&#243;s a &#250;ltima sess&#227;o de adapta&#231;&#227;o, os indiv&#237;duos realizaram o teste de uma repeti&#231;&#227;o m&#225;xima (1-RM)<sup>16</sup><sub>.</sub> O teste teve in&#237;cio com um aquecimento (10 repeti&#231;&#245;es), com aproximadamente 50% da carga estimada para a primeira tentativa, baseado na experi&#234;ncia pr&#233;via dos participantes. Em seguida, foram realizadas tr&#234;s tentativas com carga progressiva at&#233; se identificar a carga de 1-RM. Entre as tentativas, e entre os exerc&#237;cios, foi mantido um intervalo de recupera&#231;&#227;o de dois minutos. Com o objetivo de familiarizar os indiv&#237;duos ao teste<sup>17</sup>, foram realizadas 04 sess&#245;es de testes de 1-RM, com intervalo m&#237;nimo de 48 horas entre as sess&#245;es, onde a maior carga encontrada durante a realiza&#231;&#227;o dos testes foi utilizada para calcular a intensidade do exerc&#237;cio nas sess&#245;es experimentais. </p>
    <p>
      <bold>Protocolo experimental</bold>
    </p>
    <p>Ap&#243;s a determina&#231;&#227;o das cargas de 1-RM, os indiv&#237;duos foram submetidos a tr&#234;s sess&#245;es experimentais: sess&#227;o controle (C), sess&#227;o de exerc&#237;cio de for&#231;a com 50% de 1-RM (E50%) e sess&#227;o de exerc&#237;cio de for&#231;a com 70% de 1-RM (E70%). A determina&#231;&#227;o da ordem das sess&#245;es foi feita de forma aleat&#243;ria. Entre as sess&#245;es, houve um intervalo de pelo menos tr&#234;s dias. </p>
    <p>As sess&#245;es foram iniciadas no mesmo hor&#225;rio do dia. Os sujeitos foram instru&#237;dos a fazer uma refei&#231;&#227;o leve 2 horas antes dos experimentos, evitar exerc&#237;cios f&#237;sicos e ingest&#227;o de &#225;lcool por pelo menos 48 horas de anteced&#234;ncia, e de cafe&#237;na nas &#250;ltimas 12 horas, manter os hor&#225;rios de sono e atividades di&#225;rias semelhantes nas tr&#234;s sess&#245;es. Al&#233;m disso, as sess&#245;es experimentais foram agendadas em dias que os indiv&#237;duos apresentavam rotinas semelhantes.</p>
    <p>Em cada sess&#227;o experimental, chegando ao laborat&#243;rio, o indiv&#237;duo permaneceu em repouso sentado por 10 minutos. Em seguida, a frequ&#234;ncia card&#237;aca foi medida por 10 minutos cont&#237;nuos, por meio de um frequenc&#237;metro (Polar, RS 800 CX, Estados Unidos). Ap&#243;s as medidas de repouso, o indiv&#237;duo se deslocava at&#233; a sala de muscula&#231;&#227;o onde eram realizadas as sess&#245;es de exerc&#237;cio de for&#231;a ou controle. </p>
    <p>As tr&#234;s sess&#245;es foram compostas pelos 05 exerc&#237;cios descritos anteriormente, realizados em tr&#234;s s&#233;ries consecutivas de 12, 09 e 06 repeti&#231;&#245;es. Em todas as sess&#245;es (C, E50% e E70%), antes de cada exerc&#237;cio, uma s&#233;rie de aquecimento de 10 repeti&#231;&#245;es foi realizada utilizando 25% de 1-RM. Na sess&#227;o C, os sujeitos realizaram os exerc&#237;cios com uma barra de pl&#225;stico (0,1 kg) para assegurar que as diferen&#231;as encontradas em compara&#231;&#227;o com as sess&#245;es de exerc&#237;cio (E50% e E70%) se deviam &#224; intensidade empregada e n&#227;o ao movimento articular ou &#224;s altera&#231;&#245;es de postura. Nas sess&#245;es E50% e E70%, a carga dos exerc&#237;cios foi de 50% e 70% de 1-RM, respectivamente. O intervalo de recupera&#231;&#227;o entre as s&#233;ries, e entre os exerc&#237;cios em todas as sess&#245;es, foi de dois minutos.</p>
    <p>Ap&#243;s a finaliza&#231;&#227;o das interven&#231;&#245;es, o indiv&#237;duo retornava ao laborat&#243;rio, onde permanecia em repouso sentado por mais 60 minutos (per&#237;odo p&#243;s-interven&#231;&#227;o). A frequ&#234;ncia card&#237;aca foi obtida em intervalos de 10 minutos, entre os minutos 20 e 30 e 50 e 60 da recupera&#231;&#227;o.</p>
    <p>
      <bold>An&#225;lise da variabilidade da frequ&#234;ncia card&#237;aca</bold>
    </p>
    <p>A modula&#231;&#227;o auton&#244;mica do sistema cardiovascular foi obtida por meio da t&#233;cnica de an&#225;lise espectral da variabilidade da frequ&#234;ncia card&#237;aca. Para tanto, foram utilizados os intervalos R-R obtidos com o frequenc&#237;metro (Polar, RS 800 CX, Estados Unidos). Dessa forma, per&#237;odos estacion&#225;rios do tacograma, com pelo menos 500 batimentos, foram decompostos nas bandas de baixa (BF) e alta (AF) frequ&#234;ncias pelo m&#233;todo autorregressivo, utilizando-se o <italic>software</italic> Kubios HRV (Finl&#226;ndia), seguindo as recomenda&#231;&#245;es do <italic>Task Force </italic>de An&#225;lise Espectral<sup>18</sup>. Foram consideradas como fisiologicamente significativas as frequ&#234;ncias entre 0,04 e 0,4 Hz, sendo que o componente de BF foi representado pelas oscila&#231;&#245;es entre 0,04 e 0,15 Hz e o de AF pelas oscila&#231;&#245;es entre 0,15 e 0,4 Hz. O poder de cada componente espectral foi normalizado dividindo-se o poder de cada banda do espectro pela vari&#226;ncia total, da qual foi subtra&#237;do o valor de banda de muito baixa frequ&#234;ncia (&lt; 0,04 Hz), sendo o resultado multiplicado por 100. Para a interpreta&#231;&#227;o dos resultados, os componentes BF e AF normalizados da variabilidade da frequ&#234;ncia card&#237;aca foram considerados, respectivamente, como representativos da modula&#231;&#227;o predominantemente simp&#225;tica e parassimp&#225;tica do cora&#231;&#227;o, e a raz&#227;o entre estas bandas (BF/AF), como o balan&#231;o simpatovagal card&#237;aco<sup>18</sup>. </p>
    <p>An&#225;lise estat&#237;stica</p>
    <p>A normalidade e a homogeinedade de vari&#226;ncia dos dados foram confirmados pelos testes de Shapiro Wilks e de Levene, respectivamente. Os dados do per&#237;odo de pr&#233;-interven&#231;&#227;o nas tr&#234;s sess&#245;es experimentais foram comparados pela an&#225;lise de vari&#226;ncia (ANOVA) de um fator para medidas repetidas. As respostas auton&#244;micas em cada sess&#227;o experimental foram calculadas pela diferen&#231;a entre os valores medidos p&#243;s e pr&#233;-interven&#231;&#227;o (&#916;= p&#243;s - pr&#233;). As respostas da variabilidade da frequ&#234;ncia card&#237;aca ap&#243;s as tr&#234;s sess&#245;es experimentais foram comparadas pela ANOVA de dois fatores para medidas repetidas, sendo considerados como fatores principais a sess&#227;o (C, E50% e E70%) e o tempo (pr&#233;, 20 a 30 e 50 a 60 minutos). Quando observado valor de F significante, foi realizado o teste de <italic>post hoc</italic> de <italic>Newman-Keuls</italic>. O valor alfa de p &lt; 0,05 foi considerado como significante e os dados s&#227;o apresentados como m&#233;dia &#177; desvio-padr&#227;o.</p>
    <p>
      <bold>Resultados</bold>
    </p>
    <p>Todos os indiv&#237;duos inclu&#237;dos no estudo apresentaram risco cardiovascular baixo. Dos 15 sujeitos, tr&#234;s deles iniciaram o protocolo com a sess&#227;o C, 07 com a E50% e 05 com a E70%. Os testes de 1-RM e as cargas utilizadas durante as sess&#245;es de exerc&#237;cio de for&#231;a est&#227;o apresentados na <xref ref-type="table" rid="tab02">Tabela 2</xref>.</p>
    <table-wrap id="tab02">
      <graphic xlink:href="1678-4170-abc-96-06-0498-00043-gt02.jpg"/></table-wrap>
    <p>Os dados da variabilidade da frequ&#234;ncia card&#237;aca antes das interven&#231;&#245;es nas tr&#234;s sess&#245;es experimentais (C, E50% e E70%) s&#227;o apresentados na <xref ref-type="table" rid="tab03">Tabela 3</xref>. Os valores pr&#233;-exerc&#237;cio foram semelhantes entre as sess&#245;es C, E50% e E70% (p &gt; 0,05).</p>
    <table-wrap id="tab03">
      <graphic xlink:href="1678-4170-abc-96-06-0498-00043-gt03.jpg"/></table-wrap>
    <p>As altera&#231;&#245;es na modula&#231;&#227;o auton&#244;mica card&#237;aca ap&#243;s as tr&#234;s sess&#245;es experimentais est&#227;o apresentados na <xref ref-type="fig" rid="fig01">Figura 1</xref>. </p>
    <fig id="fig01">
      <graphic xlink:href="1678-4170-abc-96-06-0498-00043-gf01.jpg"/></fig>
    <p>Em compara&#231;&#227;o com os valores pr&#233;-interven&#231;&#227;o, o intervalo R-R aumentou ap&#243;s a sess&#227;o C, durante todo o per&#237;odo de recupera&#231;&#227;o (maior aumento: +112 &#177; 83 ms, p &lt; 0,01), manteve-se ap&#243;s a sess&#227;o E50%, durante todo o per&#237;odo de recupera&#231;&#227;o (p &gt; 0,05) e diminuiu durante os 30 minutos iniciais de recupera&#231;&#227;o na sess&#227;o E70% (maior queda: -69 &#177; 105 ms, p &lt; 0,01). Assim, o comportamento do intervalo R-R, durante todo o per&#237;odo de recupera&#231;&#227;o, diferiu significantemente entre as tr&#234;s sess&#245;es experimentais (p &lt; 0,05). </p>
    <p>Em compara&#231;&#227;o aos valores pr&#233;-interven&#231;&#227;o, a banda BF e a raz&#227;o BF/AF diminu&#237;ram na sess&#227;o C (maior queda: -10 &#177; 11 un.; -2 &#177; 2 respectivamente, p &lt; 0,01), mantiveram-se na sess&#227;o E50% (p &gt; 0,05) e aumentaram na sess&#227;o E70% (maior aumento: +13 &#177; 14 un.; +3 &#177; 3, respectivamente, p &lt; 0,01). Assim, o comportamento dessas vari&#225;veis, durante todo o per&#237;odo de recupera&#231;&#227;o, diferiu significantemente entre as tr&#234;s sess&#245;es experimentais (p &lt; 0,05).</p>
    <p>Comparando os valores da pr&#233;-interven&#231;&#227;o, a banda de AF aumentou na sess&#227;o C (maior aumento: +10 &#177; 11 un., p &lt; 0,01), manteve-se na sess&#227;o E50% (p &gt; 0,05) e diminuiu na sess&#227;o E70%, em todo per&#237;odo de recupera&#231;&#227;o (maior queda: -13 &#177; 14 un., p &lt; 0,01). Dessa forma, durante todo o per&#237;odo de recupera&#231;&#227;o, o comportamento da banda AF diferiu significantemente entre as tr&#234;s sess&#245;es experimentais (p &lt; 0,05).</p>
    <p>Em compara&#231;&#227;o aos valores pr&#233;-interven&#231;&#227;o, o poder total aumentou apenas na sess&#227;o C (maior aumento: +4.227 &#177; 4.328 ms<sup>2</sup>, p &lt; 0,01) e se manteve nas sess&#245;es E50% e E70%, durante todo o per&#237;odo de recupera&#231;&#227;o. Assim, o comportamento dessa vari&#225;vel, em todo o per&#237;odo de recupera&#231;&#227;o, foi diferente entre a sess&#227;o C e as sess&#245;es E50% e E70%.</p>
    <p>
      <bold>Discuss&#227;o</bold>
    </p>
    <p>Os resultados deste estudo demonstraram que o exerc&#237;cio de for&#231;a para tronco e membros superiores promoveu aumento da modula&#231;&#227;o simp&#225;tica card&#237;aca e redu&#231;&#227;o da modula&#231;&#227;o parassimp&#225;tica card&#237;aca. Al&#233;m disso, essa altera&#231;&#227;o da modula&#231;&#227;o auton&#244;mica card&#237;aca foi maior ap&#243;s o exerc&#237;cio de for&#231;a mais intenso.</p>
    <p>Durante 60 minutos ap&#243;s a sess&#227;o E70%, foram evidenciados aumento da modula&#231;&#227;o simp&#225;tica e redu&#231;&#227;o da modula&#231;&#227;o parassimp&#225;tica card&#237;aca. Esses resultados s&#227;o semelhantes aos observados em estudos anteriores que empregaram o exerc&#237;cio de for&#231;a para os principais grupamentos musculares<sup>6,8</sup> ou para os membros inferiores<sup>12</sup>. Esses resultados sugerem que independentemente dos exerc&#237;cios empregados (principais grupamentos musculares, membros inferiores ou tronco e membros superiores), a realiza&#231;&#227;o do exerc&#237;cio de for&#231;a promove altera&#231;&#245;es na modula&#231;&#227;o auton&#244;mica card&#237;aca, que permanecem por um longo per&#237;odo ap&#243;s a finaliza&#231;&#227;o da sess&#227;o.</p>
    <p>Os mecanismos envolvidos nessa resposta n&#227;o foram estudados no presente estudo. Todavia, &#233; poss&#237;vel que na sess&#227;o controle o estresse ortost&#225;tico, ocasionado pelo per&#237;odo prolongado na posi&#231;&#227;o sentada, promova diminui&#231;&#227;o do retorno venoso e aumento da atividade nervosa simp&#225;tica perif&#233;rica, estimulando o barorreflexo<sup>19,20</sup>. Esse est&#237;mulo, por sua vez, promove a diminui&#231;&#227;o da atividade nervosa simp&#225;tica e aumento da atividade parassimp&#225;tica card&#237;acas<sup>21</sup>. Por outro lado, na sess&#227;o de exerc&#237;cio de for&#231;a, possivelmente ocorre maior redu&#231;&#227;o do retorno venoso, desativando os receptores cardiopulmonares<sup>6</sup>, uma vez que, ap&#243;s essas sess&#245;es, n&#227;o foi observada hipotens&#227;o p&#243;s-exerc&#237;cio<sup>21</sup>. Al&#233;m disso, o estresse ortost&#225;tico parece potencializar tal resposta, uma vez que a recupera&#231;&#227;o da frequ&#234;ncia card&#237;aca na posi&#231;&#227;o sentada parece ser mais prolongada em compara&#231;&#227;o &#224; posi&#231;&#227;o supina<sup>22</sup>.</p>
    <p>No presente estudo, comparado ao exerc&#237;cio de for&#231;a realizado a 50% de 1-RM, o exerc&#237;cio de for&#231;a realizado com 70% de 1-RM promoveu maior aumento da modula&#231;&#227;o auton&#244;mica simp&#225;tica card&#237;aca. Esses resultados s&#227;o diferentes dos observados por Rezk e cols.<sup>6</sup>, que verificaram altera&#231;&#227;o semelhante na modula&#231;&#227;o auton&#244;mica card&#237;aca ap&#243;s a realiza&#231;&#227;o do exerc&#237;cio de for&#231;a com 80% de 1-RM e com 40% de 1-RM at&#233; a fadiga. Essa controv&#233;rsia foi possivelmente ocasionada pela varia&#231;&#227;o do n&#250;mero de repeti&#231;&#245;es entre as intensidades no estudo de Rezk <italic>e </italic>cols.<sup>6</sup>, o que n&#227;o aconteceu no presente estudo. Esses resultados indicam que o aumento da modula&#231;&#227;o simp&#225;tica card&#237;aca p&#243;s-exerc&#237;cio de for&#231;a &#233; dependente da intensidade do exerc&#237;cio, desde que o n&#250;mero de repeti&#231;&#245;es realizadas seja o mesmo. </p>
    <p>Com rela&#231;&#227;o &#224; dura&#231;&#227;o das altera&#231;&#245;es auton&#244;micas card&#237;acas ap&#243;s o exerc&#237;cio de for&#231;a, Rezk e cols.<sup>6</sup> evidenciaram que, 75 minutos ap&#243;s o exerc&#237;cio de for&#231;a, a modula&#231;&#227;o auton&#244;mica simp&#225;tica card&#237;aca continuava elevada. Esses resultados s&#227;o semelhantes aos observados na sess&#227;o E70% do presente estudo, em que as altera&#231;&#245;es na modula&#231;&#227;o auton&#244;mica ocorreram at&#233; os 60 minutos de recupera&#231;&#227;o. Por outro lado, na sess&#227;o E50%, os valores da modula&#231;&#227;o auton&#244;mica card&#237;aca nos 60 minutos p&#243;s-exerc&#237;cio foram similares aos de repouso. Considerando que na E70% os indiv&#237;duos chegavam muito pr&#243;ximo &#224; fadiga em cada s&#233;rie, o que n&#227;o acontecia na E50%, &#233; poss&#237;vel sugerir que a realiza&#231;&#227;o dos exerc&#237;cios de for&#231;a at&#233; pr&#243;ximo &#224; fadiga resulte numa maior e mais duradoura ativa&#231;&#227;o simp&#225;tica card&#237;aca<sup>9,10</sup>. Essa resposta possivelmente est&#225; relacionada a maior sobrecarga mec&#226;nica do sistema vascular no exerc&#237;cio de maior intensidade, que promove maior ativa&#231;&#227;o dos mecanorreceptores<sup>23</sup> e a maior ativa&#231;&#227;o do metaborreflexo decorrente da redu&#231;&#227;o do fluxo sangu&#237;neo<sup>12</sup>. Outro poss&#237;vel mecanismo &#233; a maior diminui&#231;&#227;o do volume plasm&#225;tico, ap&#243;s o exerc&#237;cio de for&#231;a com maior intensidade, devido ao extravasamento de sangue para o espa&#231;o intersticial, promovendo assim diminui&#231;&#227;o do retorno venoso. Isso, por sua vez, resultaria na desativa&#231;&#227;o dos receptores cardiopulmonares, e no consequente aumento da frequ&#234;ncia card&#237;aca. Todavia, essas hip&#243;teses ainda precisam ser testadas.</p>
    <p>Os resultados deste estudo apresentam aplica&#231;&#245;es pr&#225;ticas importantes. O aumento da modula&#231;&#227;o simp&#225;tica e a diminui&#231;&#227;o da modula&#231;&#227;o parassimp&#225;tica card&#237;acas est&#227;o relacionados ao aumento do risco cardiovascular<sup>9,10</sup>. Assim, &#233; poss&#237;vel sugerir que o exerc&#237;cio de for&#231;a para tronco e membros superiores com 70% de 1-RM promove uma transiente altera&#231;&#227;o na modula&#231;&#227;o auton&#244;mica card&#237;aca, que pode representar um aumento no risco cardiovascular, o que n&#227;o acontece quando utilizado 50% de 1-RM. Dessa forma, a prescri&#231;&#227;o do exerc&#237;cio de for&#231;a com 50% de 1-RM pode ser uma importante estrat&#233;gia para minimizar o risco naqueles indiv&#237;duos que apresentam maior risco cardiovascular. Todavia, essa hip&#243;tese precisa ser confirmada em estudos futuros. </p>
    <p>Este estudo apresenta limita&#231;&#245;es que devem ser consideradas. N&#227;o houve controle sobre a frequ&#234;ncia respirat&#243;ria dos indiv&#237;duos em nenhum dos momentos das sess&#245;es experimentais. Dessa forma, &#233; poss&#237;vel que os movimentos respirat&#243;rios possam ter influenciado no poder da banda de alta frequ&#234;ncia. Os indiv&#237;duos no presente estudo eram jovens e saud&#225;veis e a extrapola&#231;&#227;o dos resultados para indiv&#237;duos com outras caracter&#237;sticas &#233; limitada. Todavia, considerando a escassez de dados sobre esse tema na literatura, os resultados deste estudo fornecem indicativos iniciais sobre o impacto do exerc&#237;cio de for&#231;a na modula&#231;&#227;o auton&#244;mica card&#237;aca.</p>
    <p>Finalmente, embora a ordem de realiza&#231;&#227;o das sess&#245;es tenha sido aleatorizada, a aleatoriza&#231;&#227;o resultou em uma distribui&#231;&#227;o n&#227;o balanceada entre as sess&#245;es. Por&#233;m, acreditamos que a probabilidade desse fator ter impactado consideravelmente os resultados &#233; m&#237;nima. </p>
    <p>
      <bold>Conclus&#227;o</bold>
    </p>
    <p>Ap&#243;s uma sess&#227;o aguda de exerc&#237;cio de for&#231;a para tronco e membros superiores, ocorre aumento na modula&#231;&#227;o simp&#225;tica e redu&#231;&#227;o da modula&#231;&#227;o parassimp&#225;tica card&#237;aca. Essas respostas s&#227;o mais acentuadas na sess&#227;o com maior intensidade.</p>
    <p>
      <bold>Potencial Conflito de Interesses</bold>
    </p>
    <p>Declaro n&#227;o haver conflito de interesses pertinentes.</p>
    <p>
      <bold>Fontes de Financiamento</bold>
    </p>
    <p>O presente estudo foi financiado pela Funda&#231;&#227;o de Amparo a Ci&#234;ncia e Tecnologia do Estado de Pernambuco (FACEPE); Programa de Fortalecimento Acad&#234;mico da Universidade de Pernambuco (PFA-UPE); Conselho Nacional de Desenvolvimento Cient&#237;fico e Tecnol&#243;gico (CNPq) .</p>
    <p>
      <bold>Vincula&#231;&#227;o Acad&#234;mica</bold>
    </p>
    <p>N&#227;o h&#225; vincula&#231;&#227;o deste estudo a programas de p&#243;s-gradua&#231;&#227;o.</p>
    <p>
      <fn id="end" fn-type="corresp">
        <p>Correspond&#234;ncia:</p>
        <p>Raphael Mendes Ritti Dias </p>
        <p> Rua Arn&#237;bio Marques, 310 - Santo Amaro </p>
        <p> 50100-130 - Recife, PE - Brasil </p>
        <p> E-mail: </p>
        <p>
          <email xlink:href="raphaelritti@gmail.com">raphaelritti@gmail.com</email>
        </p>
      </fn>
    </p>
    <p> Artigo recebido em 04/09/10; revisado recebido em 03/11/10; aceito em 25/11/10</p>
    <p>Full texts in English - <ext-link ext-link-type="uri" xlink:href="http://www.arquivosonline.com.br">http://www.arquivosonline.com.br</ext-link></p>
  </body>
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  <sub-article article-type="translation" id="TRen" xml:lang="en">
    <front-stub>
      <article-categories>
        <subj-group subj-group-type="heading">
          <subject>Original Articles</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title xml:lang="en">Acute effect of resistance exercise intensity in cardiac autonomic modulation after exercise</article-title>
      </title-group>
      <abstract xml:lang="en">
        <p>BACKGROUND: Cardiac sympathovagal balance is altered after resistance exercise. However, the impact of the characteristics of resistance training in this response remains unclear. OBJECTIVE: Analyze the acute effect of resistance exercise intensity for trunk and upper limbs in cardiac autonomic modulation after exercise. METHODS: Fifteen young men performed three experimental sessions in random order: control (C), resistance exercise with 50% of 1-RM (E50%) and resistance exercise with 70% of 1-RM (E70%). The sessions included 05 exercises for the trunk and upper limbs performed in three sets of 12, 9 and 6 repetitions, respectively. Before and at 20 and 50 minutes after the interventions, the heart rate was measured for spectral analysis of variability. RESULTS: In comparison to the values before the intervention, the RR interval and the band of high frequency (HF) increased (major changes: + 112 &#177; 83 ms; +10 &#177; 11 un, respectively, p &lt; 0.01), while the low frequency band (LF) and LF/HF ratio decreased (major changes: -10 &#177; 11 pc; -2 &#177; 2, respectively, p &lt; 0.01) after the session C. None of these variables changed significantly after the E50% session (p &gt; 0.05). Compared to pre-exercise values, the RR interval and the HF band decreased (major changes: -69 &#177; 105 ms; -13 &#177; 14 un, respectively, p &lt;0.01), while the LF band and the LF/HF ratio increased (major changes: -13 &#177; 14 un, 13 &#177; 3 14 &#177; 3 and un, respectively, p &lt;0.01) after E70%. CONCLUSION: The higher intensity of resistance exercise for trunk and upper limbs promoted, in an acute manner, greater increase in cardiac sympathovagal balance after exercise.</p>
      </abstract>
      <kwd-group xml:lang="en">
        <kwd>Exercise</kwd>
        <kwd>physical exertion</kwd>
        <kwd>autonomic nervous system</kwd>
        <kwd>sympathetic nervous system</kwd>
      </kwd-group>
    </front-stub>
    <body>
      <p><undefined id="title-body2"/>Acute effect of resistance exercise intensity in cardiac autonomic modulation after exercise</p>
      <p>
        <bold>Alu&#237;sio Henrique Rodrigues de Andrade Lima<sup>I</sup>; Cl&#225;udia L&#250;cia de Moraes Forjaz<sup>II</sup>; Gleyson Queiroz de Moraes Silva<sup>I</sup>; Annelise Lins Men&#234;ses<sup>I</sup>; Anderson Jos&#233; Melo Rodrigues Silva<sup>I</sup>; Raphael Mendes Ritti-Dias<sup>I</sup></bold>
      </p>
      <p><sup>I</sup>Escola Superior de Educa&#231;&#227;o F&#237;sica - Universidade de Pernambuco, Recife, PE</p>
      <p><sup>II</sup>Escola de Educa&#231;&#227;o F&#237;sica e Esportes - Universidade de S&#227;o Paulo, S&#227;o Paulo, SP - Brazil</p>
      <p>Mailing address</p>
      <p>
        <bold>ABSTRACT</bold>
      </p>
      <p><bold>BACKGROUND: </bold>Cardiac sympathovagal balance is altered after resistance exercise. However, the impact of the characteristics of resistance training in this response remains unclear.</p>
      <p><bold>OBJECTIVE: </bold>Analyze the acute effect of resistance exercise intensity for trunk and upper limbs in cardiac autonomic modulation after exercise.</p>
      <p><bold>METHODS: </bold>Fifteen young men performed three experimental sessions in random order: control (C), resistance exercise with 50% of 1-RM (E50%) and resistance exercise with 70% of 1-RM (E70%). The sessions included 05 exercises for the trunk and upper limbs performed in three sets of 12, 9 and 6 repetitions, respectively. Before and at 20 and 50 minutes after the interventions, the heart rate was measured for spectral analysis of variability.</p>
      <p><bold>RESULTS: </bold>In comparison to the values before the intervention, the RR interval and the band of high frequency (HF) increased (major changes: + 112 &#177; 83 ms; +10 &#177; 11 un, respectively, p &lt; 0.01), while the low frequency band (LF) and LF/HF ratio decreased (major changes: -10 &#177; 11 pc; -2 &#177; 2, respectively, p &lt; 0.01) after the session C. None of these variables changed significantly after the E50% session (p&gt; 0.05). Compared to pre-exercise values, the RR interval and the HF band decreased (major changes: -69 &#177; 105 ms; -13 &#177; 14 un, respectively, p &lt; 0.01), while the LF band and the LF/HF ratio increased (major changes: -13 &#177; 14 un, 13 &#177; 3 14 &#177; 3 and un, respectively, p &lt; 0.01) after E70%.</p>
      <p><bold>CONCLUSION: </bold>The higher intensity of resistance exercise for trunk and upper limbs promoted, in an acute manner, greater increase in cardiac sympathovagal balance after exercise. </p>
      <p><bold>Keywords: </bold>Exercise; physical exertion; autonomic nervous system; sympathetic nervous system.</p>
      <p>
        <bold>Introduction</bold>
      </p>
      <p>Resistance exercise is recommended for healthy individuals<sup>1,2 </sup>and those with heart diseases<sup>3</sup> due to benefits on fitness<sup>4</sup>, health<sup>4</sup> and quality of life<sup>5</sup>. However, after the completion of the resistance exercise, the cardiac sympathetic modulation remains high, while the parasympathetic modulation remains reduced<sup>6-8</sup>, which may increase the risk of acute cardiovascular events<sup>9,10</sup>. </p>
      <p>Health institutions, such as the American College of Sports Medicine, recommend that the program of resistance training be divided into two sessions: one with exercises for the lower limbs and another with exercises for the upper limbs<sup>11</sup>. A recent study<sup>12</sup> showed that performing exercises only for the lower limbs improves the cardiac sympathovagal balance after exercise. However, the impact of exercises for the trunk and upper limbs in these responses has not been studied. Because the cardiovascular response to resistance exercise is dependent on the amount of muscle mass involved<sup>13</sup>, it is possible that the autonomic responses after trunk and upper limb exercise be different, which requires further analysis.</p>
      <p>Another important aspect concerns the overload during exercise. A previous study<sup>6</sup> reported that the two protocols of resistance exercise (10 reps at 80% of 1RM and 20 reps at 40% of 1RM) cause similar alterations in cardiac autonomic modulation. However, since the protocols differed in the volume (number of repetitions) and intensity (overload), it was not possible to establish clearly the isolated impact of exercise intensity in cardiac autonomic modulation after exercise. As the intensity of resistance exercise affects the metabolic and mechanical responses in the vasculature, and consequently in the reflex mechanisms of cardiovascular control, it is possible that different intensities of resistance exercise promote different responses in cardiac autonomic modulation after exercise.</p>
      <p>Hence, the purpose of this study is to analyze the acute effect of resistance exercise intensity for trunk and upper limbs in cardiac autonomic modulation after exercise. Our hypothesis is that the sympathovagal balance increases after exercise regardless of the intensity used, but a greater magnitude and longer duration of this response will be observed after an exercise session with increased intensity.</p>
      <p>
        <bold>Methods</bold>
      </p>
      <p>
        <bold>Sample</bold>
      </p>
      <p>The sample included 15 men aged 18 to 25 years, recruited at the university and local communities. Before entering the study, the individuals were informed about the procedures they would be exposed, and those who agreed to participate signed a consent form. This study was approved by the Ethics Committee of the institution to which the authors belong (223/08). As inclusion criteria for this study, the individuals should be well nourished, not present any cardiovascular disease, not on medication and in the 06 months before the study, they could not be practicing any kind of physical exercise.</p>
      <p>
        <bold>Clinical data</bold>
      </p>
      <p>To obtain the clinical data of individuals, we raised a medical history that included questions on cardiovascular risk factors. In possession of the data, the individuals were stratified with respect to cardiovascular risk at high, moderate or low level<sup>1</sup>. </p>
      <p>Besides the medical history, anthropometric measurements and blood pressure were assessed. Body weight and height were measured using a digital scale with 0.1 kg precision (Filizola, Brazil) and a wooden stadiometer with accuracy of 0.1 cm, respectively. Blood pressure was measured by auscultation with the volunteers sitting and at rest, three consecutive times after 05 minutes of rest, in two separate visits<sup>14</sup>. To remain in the study, the individuals were required to be normotensive, thereby presenting (and to present) systolic blood pressure smaller than or equal to 120 mmHg and diastolic blood pressure smaller than or equal to 80 mmHg<sup>14</sup>. This level of pressure was chosen because individuals with values above those already present changes in cardiac sympathovagal balance<sup>15</sup>.</p>
      <p>The clinical characteristics of the individuals are presented in <xref ref-type="table" rid="tab01-body2">Table 1</xref>.</p>
      <table-wrap id="tab01-body2">
        <graphic xlink:href="1678-4170-abc-96-06-0498-00043-gt01-en.jpg"/></table-wrap>
      <p>
        <bold>Adaptation sessions and test with one maximum repetition (1-RM)</bold>
      </p>
      <p>Before the experimental sessions, each individual participated in two sessions to adapt to resistance exercises, performed on different days. In each adaptation session, the individuals performed three sets of 12 repetitions with the minimum permissible load in the following exercises: i) bench press, ii) barbell rows, iii) front lifting, iv) curl and v) triceps curl. All exercises included in the study were performed with free weights. </p>
      <p>Two days after the last adaptation session, the individuals performed the maximum repetition test (1-RM)<sup>16</sup>. The test began with a warm-up (10 reps), with approximately 50% of the estimated load for the first attempt, based on the previous experience of participants. Then, there were three attempts with progressive to load until the load of 1-RM was identified. Between the attempts, and between the exercises, we maintained a recovery interval of two minutes. In order to familiarize the individuals with the test<sup>17</sup>, we performed 04 test sessions of 1-RM, with a minimum interval of 48 hours between sessions, where the highest load found during the tests was used to calculate the exercise intensity in the experimental sessions. </p>
      <p>
        <bold>Experimental protocol</bold>
      </p>
      <p>After determining the loads of 1-RM, the individuals underwent three experimental sessions: control (C), resistance exercise with 50% of 1-RM (E50%) and resistance exercise with 70% of 1-RM (E70%). The order of sessions was randomly determined. Between sessions, there was an interval of at least three days. </p>
      <p>The sessions started at the same time of the day. The individuals were instructed to have a light meal two hours before the experiments, avoid exercise and alcohol intake for at least 48 hours in advance, and caffeine in the last 12 hours, as well as keep similar sleep schedules and daily activities in all three sessions. Moreover, the experimental sessions were scheduled on days on which the individuals had similar routines.</p>
      <p>In each experimental session, each individual remained sitting at rest for 10 minutes by the time they got to the laboratory. Then, the heart rate was measured for 10 continuous minutes, using a frequency meter (Polar, RS 800 CX, USA). After resting measurements, the individuals would move to the weight-lifting room where they performed the sessions of resistance or control exercise. </p>
      <p>The three sessions were composed of the 05 exercises described above, performed in three consecutive sets of 12, 9 and 06 repetitions. In all sessions (C, E50% and E70%) before each exercise, a warm-up series of 10 repetitions was performed using 25% of 1-RM. In session C, the individuals performed the exercises with a plastic bar (0.1 kg) to ensure that the differences found in comparison with exercise sessions (E50% and E70%) were due to the intensity used other than the motion or changes in posture. In sessions E50% and E70%, the load of the exercises was 50% and 70% of 1-RM, respectively. The resting interval between the series and between the exercises in every session lasted two minutes.</p>
      <p>After completion of the interventions, the individuals returned to the laboratory, where they remained sitting at rest for more 60 minutes (post-intervention period). Heart rate was obtained at intervals of 10 minutes, between 20 and 30 and 50 and 60 minutes of recovery.</p>
      <p>
        <bold>Analysis of heart rate variability</bold>
      </p>
      <p>The autonomic modulation of the cardiovascular system was obtained by the technique of spectral analysis of heart rate variability. For this purpose, we used the RR intervals obtained from the frequency meter (Polar, RS 800 CX, USA). Hence, stationary periods of the tachogram, with at least 500 beats, were broken down into bands of low (LF) and high (HF) frequencies using the autoregressive method, using the software Kubios HRV (Finland), following the recommendations of the Task Force of Spectral Analysis<sup>18</sup>. Frequencies between 0.04 and 0.4 Hz were considered as physiologically significant, whereas the LF component was represented by oscillations between 0.04 and 0.15 Hz and HF was represented by oscillations between 0.15 and 0.4 Hz. The power of each spectral component was normalized by dividing the power of each spectrum band by the total variance, minus the value of very low frequency band (&lt;0.04 Hz), and multiplying the result by 100. For interpreting the results, the LF and HF normalized components of heart rate variability were considered, respectively, as representative of predominantly sympathetic and parasympathetic modulation of the heart, and the ratio between these bands (LF/HF) as the cardiac sympathovagal balance<sup>18</sup>. </p>
      <p>
        <bold>Statistical analysis</bold>
      </p>
      <p>The normality and homogeneity of variance of data were confirmed by the Shapiro Wilks and Levene tests, respectively. Data from the pre-intervention period in the three experimental sessions were compared by the analysis of variance (ANOVA) of one factor for repeated measures. Autonomic responses in each experimental session were calculated as the difference between the values measured after and before the intervention (&#916;= after - before). The responses of heart rate variability after the three experimental sessions were compared by two-factor ANOVA for repeated measures, considering the session (C, E50% and E70%) and time (before, 20 to 30 and 50 to 60 minutes) as major factors. When F value was significant, we performed post hoc Newman-Keuls test. The alpha value of p &lt; 0.05 was considered significant and data are presented as mean &#177; standard deviation.</p>
      <p>
        <bold>Results</bold>
      </p>
      <p>All individuals included in the study had low cardiovascular risk. Out of the 15 individuals, three of them started the protocol with session C, 07 with E50% and 05 with E70%. Tests of 1-RM and the loads used during the sessions of resistance exercise are presented in <xref ref-type="table" rid="tab02-body2">Table 2</xref>.</p>
      <table-wrap id="tab02-body2">
        <graphic xlink:href="1678-4170-abc-96-06-0498-00043-gt02-en.jpg"/></table-wrap>
      <p>The data of heart rate variability before the interventions in the three experimental sessions (C, E50% and E70%) are presented in <xref ref-type="table" rid="tab03-body2">Table 3</xref>. The pre-exercise values were similar between sessions C, E50% and E70% (p &gt; 0.05).</p>
      <table-wrap id="tab03-body2">
        <graphic xlink:href="1678-4170-abc-96-06-0498-00043-gt03-en.jpg"/></table-wrap>
      <p>Changes in cardiac autonomic modulation after the three experimental sessions are shown in <xref ref-type="fig" rid="fig01-body2">Figure 1</xref>. </p>
      <fig id="fig01-body2">
        <graphic xlink:href="1678-4170-abc-96-06-0498-00043-gf01-en.jpg"/></fig>
      <p>Compared with pre-intervention values, the RR interval increased after the C session, throughout the recovery period (greatest increase: +112 &#177; 83 ms, p &lt; 0,01), remained steady after the session E50%, throughout the recovery period (p &gt; 0.05) and decreased over the first 30 minutes of recovery at session E70% (greatest drop: -105 &#177; 69 ms, p &lt; 0.01). Thus, the behavior of the RR interval throughout the recovery period differed significantly between the three experimental sessions (p &lt; 0.05). </p>
      <p>Compared to the pre-intervention values, the BF band and LF/HF ratio decreased in session C (greatest drop: -10 &#177; 11 un., -2 &#177; 2, respectively, p &lt; 0.01), remained steady in session E50% (p &gt; 0.05) and increased in session E70% (greatest increase: +13 &#177; 14 un.; +3 &#177; 3, respectively, p &lt; 0.01). Thus, the behavior of these variables throughout the recovery period differed significantly between the three experimental sessions (p &lt; 0.05).</p>
      <p>Comparing the pre-intervention values, the HF band increased in session C (greatest increase: +10 &#177; 11 un., p &lt; 0.01), remained steady in session E50% (p &gt; 0.05) and decreased in session E70% throughout the recovery period (greatest drop: -13 &#177; 14 un., p &lt; 0.01). Thus, throughout the recovery period, the behavior of HF band differed significantly between the three experimental sessions (p &lt; 0.05).</p>
      <p>Comparing the pre-intervention values, the total power increased only in session C (greatest increase: +4,227 &#177; 4,328 ms<sup>2</sup>, p &lt; 0.01) and remained steady in sessions E50% and E70% throughout the recovery period. Thus, the behavior of this variable throughout the recovery period was different between the session C and the sessions E50% and E70%.</p>
      <p>
        <bold>Discussion</bold>
      </p>
      <p>The results of this study demonstrate that the resistance exercise for trunk and upper limbs led to an increased cardiac sympathetic modulation and reduced cardiac parasympathetic modulation. Moreover, this change in the cardiac autonomic modulation was higher after a more intense resistance exercise.</p>
      <p>Over 60 minutes after the session E70%, we saw an increased sympathetic modulation and reduced cardiac parasympathetic modulation. These results are similar to those observed in previous studies that used resistance exercise for key muscle groups<sup>6,8</sup> or for lower limbs<sup>12</sup>. These results suggest that regardless of the exercises employed (major muscle groups, lower limbs or trunk and upper limbs), the completion of resistance exercise causes changes in cardiac autonomic modulation, which remain for a long period after the completion of the session.</p>
      <p>The mechanisms involved in this response were not investigated in this study. Nevertheless, it is possible that in the control session, the orthostatic stress caused by prolonged sitting promotes decreased venous return and increased peripheral sympathetic nerve activity stimulating the baroreflex<sup>19,20</sup>. This stimulation, in turn, promotes a decrease in sympathetic nerve activity and increase in cardiac parasympathetic activity<sup>21</sup>. On the other hand, the session of resistance exercise potentially leads to a greater reduction in venous return, deactivating cardiopulmonary receptors<sup>6</sup>, since, after these sessions, there was no post-exercise hypotension<sup>21</sup>. Furthermore, the orthostatic stress seems to enhance this response, since the restoration of heart rate while sitting seems to last longer compared to the supine position<sup>22</sup>.</p>
      <p>In this study, compared to the resistance exercise at 50% of 1-RM, the resistance exercise performed with 70.0% of 1-RM caused a greater increase in sympathetic cardiac autonomic modulation. These results are different from those observed by Rezk et al<sup>6</sup>, who observed similar changes in cardiac autonomic modulation after the completion of resistance exercise with 80% of 1-RM and 40% of 1-RM until fatigue. This controversy was possibly caused by the variation in the number of repetitions between the intensities in the study by Rezk et al<sup>6</sup>, which did not happened in this study. These results indicate that increased cardiac sympathetic modulation after resistance exercise depends on exercise intensity, as long as the number of repetitions is the same. </p>
      <p>Regarding the duration of cardiac autonomic changes after the resistance exercise, Rezk et al<sup>6 </sup>showed that 75 minutes after the resistance exercise, the sympathetic cardiac autonomic modulation remained high. These results are similar to those observed in the session E70% of this study, where changes in autonomic modulation occurred within 60 minutes of recovery. On the other hand, in the E50% session, the values of cardiac autonomic modulation in 60 minutes after exercise were similar to those at rest. Considering that in session E70% the individuals came very close to fatigue in each series, which was not the case in session E50%, we could suggest that the resistance exercises close to fatigue result in a greater and longer lasting cardiac sympathetic activation<sup>9,10</sup>. This response is possibly related to higher mechanical loads of the vascular system in higher intensity exercise, which promotes increased activation of mechanoreceptors<sup>23</sup> and increased activation of metaborreflex from reduced blood flow<sup>12</sup>. Another possible mechanism is the greater decrease in plasma volume after resistance exercise with greater intensity due to leakage of blood into the interstitial space, thus promoting a decrease in venous return. This, in turn, would result in the deactivation of cardiopulmonary receptors, and the consequent increase in heart rate. However, these hypotheses remain to be tested.</p>
      <p>These results have important practical applications. The increased sympathetic modulation and reduced cardiac parasympathetic modulation relate to increased cardiovascular risk<sup>9,10</sup>. Thus, it is possible to suggest that resistance exercise for trunk and upper limbs with 70% of 1-RM promotes a transient alteration in cardiac autonomic modulation, which may represent an increased cardiovascular risk, which does not happen when using 50% of 1-RM. Thus, the prescription of resistance exercise with 50% of 1-RM can be an important strategy to minimize the risk in those individuals with higher cardiovascular risk. However, this hypothesis needs to be confirmed in future studies. </p>
      <p>This study has limitations that should be considered. There was no control over the respiratory frequency of individuals at any moment of the experimental sessions. Thus, it is possible that respiratory movements may have influenced the power of high-frequency band. The individuals in this study were young and healthy and extrapolating the results to individuals with other characteristics is limited. However, given the paucity of data on this theme in literature, the results of this study provide initial indications on the impact of resistance exercise on cardiac autonomic modulation.</p>
      <p>Finally, although the order of the sessions was randomized, the randomization resulted in an unbalanced distribution between sessions. However, we believe that the probability that this factor has impacted considerably the results is minimal. </p>
      <p>
        <bold>Conclusion</bold>
      </p>
      <p>After an acute session of resistance exercise for trunk and upper limbs, there is an increase in sympathetic modulation and reduced cardiac parasympathetic modulation. These responses are more pronounced in the session with increased intensity.</p>
      <p>
        <bold>Potential Conflict of Interest</bold>
      </p>
      <p>No potential conflict of interest relevant to this article was reported.</p>
      <p>
        <bold>Sources of Funding</bold>
      </p>
      <p>This study was funded by <italic>Funda&#231;&#227;o de Amparo a Ci&#234;ncia e Tecnologia do Estado de Pernambuco </italic>(FACEPE); <italic>Programa de Fortalecimento Acad&#234;mico da Universidade de Pernambuco </italic>(PFA-UPE); <italic>Conselho Nacional de Desenvolvimento Cient&#237;fico e Tecnol&#243;gico </italic>(CNPq) .</p>
      <p>
        <bold>Study Association</bold>
      </p>
      <p>This study is not associated with any post-graduation program.</p>
      <p>
        <bold>References</bold>
      </p>
    </body>
  </sub-article>
  <sub-article article-type="translation" id="TRes" xml:lang="es">
    <front-stub>
      <article-categories/>
      <title-group>
        <article-title xml:lang="es">Efecto agudo de intensidad del ejercicio de fuerza en la modulaci&#243;n aut&#243;noma del coraz&#243;n post-ejercicio</article-title>
      </title-group>
      <abstract xml:lang="es">
        <p>FUNDAMENTO: El balance simpatovogal card&#237;aco se altera despu&#233;s del ejercicio de fuerza. Sin embargo, el impacto de las caracter&#237;sticas del entrenamiento de fuerza en esta respuesta no est&#225; claro. OBJETIVO: Analizar el efecto agudo de intensidad del ejercicio de fuerza para el tronco y miembros en la modulaci&#243;n auton&#243;mica del coraz&#243;n post-ejercicio. M&#201;TODOS: Quince hombres j&#243;venes realizaron tres sesiones experimentales en orden aleatorio: control (C), ejercicio de fuerza con el 50% de 1-RM (E50%) y ejercicio de fuerza con el 70% de 1-RM (E70%). Las sesiones incluyeron 05 ejercicios para tronco y miembro superior, realizados en tres series de 12, 9 y 6 repeticiones, respectivamente. Antes y a los 20 y 50 minutos despu&#233;s de las intervenciones, la frecuencia cardiaca se midi&#243; para un an&#225;lisis espectral posterior de su variabilidad. RESULTADOS: En comparaci&#243;n con los valores anteriores de la intervenci&#243;n, el intervalo RR y la banda de alta frecuencia (AF) se increment&#243; (cambios importantes: + 112 &#177; 83 ms; +10 &#177; 11 un, respectivamente, p &lt; 0,01), mientras que la banda de baja frecuencia (BF) y la raz&#243;n BF/AF disminuyeron (cambios importantes: -10 &#177; 11 un; -2 &#177; 2, respectivamente, p &lt; 0,01) tras la sesi&#243;n C. Ninguna de estas variables se alter&#243; significantemente tras la sesi&#243;n E50% (p &gt; 0,05). En comparaci&#243;n a los valores pre ejercicio, el intervalo RR y la banda AF disminuyeron (cambios importantes: -69 &#177; 105 ms; -13 &#177; 14 un, respectivamente, p &lt; 0,01), mientras que la banda BF y la raz&#243;n BF/AF aumentaron (cambios importantes: -13 &#177; 14 un, +13 &#177; 14 un y +3 &#177; 3 un, respectivamente, p &lt; 0,01) tras la E70%. CONCLUSI&#211;N: La mayor intensidad de ejercicio de fuerza para el tronco y miembros superiores produjo de modo agudo, un mayor incremento simpatovagal card&#237;aco post-ejercicio.</p>
      </abstract>
      <kwd-group xml:lang="es">
        <kwd>Ejercicio</kwd>
        <kwd>esfuerzo f&#237;sico</kwd>
        <kwd>sistema nervioso aut&#243;nomo</kwd>
        <kwd>sistema nervioso simp&#225;tico</kwd>
      </kwd-group>
    </front-stub>
    <body>
      <p>
        <bold>ART&#205;CULO ORIGINAL</bold>
      </p>
      <p>
        <fn id="ab-body3">
          <label>
            <bold>Efecto agudo de intensidad del ejercicio de fuerza en la modulaci&#243;n aut&#243;noma del coraz&#243;n post-ejercicio</bold>
          </label>
          <p>
            <bold>Alu&#237;sio Henrique Rodrigues de Andrade Lima<sup>I</sup>; Cl&#225;udia L&#250;cia de Moraes Forjaz<sup>II</sup>; Gleyson Queiroz de Moraes Silva<sup>I</sup>; Annelise Lins Men&#234;ses<sup>I</sup>; Anderson Jos&#233; Melo Rodrigues Silva<sup>I</sup>; Raphael Mendes Ritti-Dias<sup>I</sup></bold>
          </p>
        </fn>
      </p>
      <p><sup>I</sup>Escola Superior de Educa&#231;&#227;o F&#237;sica - Universidade de Pernambuco, Recife, PE</p>
      <p><sup>II</sup>Escola de Educa&#231;&#227;o F&#237;sica e Esportes - Universidade de S&#227;o Paulo, S&#227;o Paulo, SP - Brasil</p>
      <p>Correspondencia</p>
      <p>
        <bold>RESUMEN</bold>
      </p>
      <p><bold>FUNDAMENTO:</bold> El balance simpatovogal card&#237;aco se altera despu&#233;s del ejercicio de fuerza. Sin embargo, el impacto de las caracter&#237;sticas del entrenamiento de fuerza en esta respuesta no est&#225; claro.</p>
      <p><bold>OBJETIVO:</bold> Analizar el efecto agudo de intensidad del ejercicio de fuerza para el tronco y miembros en la modulaci&#243;n auton&#243;mica del coraz&#243;n post-ejercicio.</p>
      <p><bold>M&#201;TODOS:</bold> Quince hombres j&#243;venes realizaron tres sesiones experimentales en orden aleatorio: control (C), ejercicio de fuerza con el 50% de 1-RM (E50%) y ejercicio de fuerza con el 70% de 1-RM (E70%). Las sesiones incluyeron 05 ejercicios para tronco y miembro superior, realizados en tres series de 12, 9 y 6 repeticiones, respectivamente. Antes y a los 20 y 50 minutos despu&#233;s de las intervenciones, la frecuencia cardiaca se midi&#243; para un an&#225;lisis espectral posterior de su variabilidad.</p>
      <p><bold>RESULTADOS:</bold> En comparaci&#243;n con los valores anteriores de la intervenci&#243;n, el intervalo RR y la banda de alta frecuencia (AF) se increment&#243; (cambios importantes: + 112 &#177; 83 ms; +10 &#177; 11 un, respectivamente, p &lt; 0,01), mientras que la banda de baja frecuencia (BF) y la raz&#243;n BF/AF disminuyeron (cambios importantes: -10 &#177; 11 un; -2 &#177; 2, respectivamente, p &lt; 0,01) tras la sesi&#243;n C. Ninguna de estas variables se alter&#243; significantemente tras la sesi&#243;n E50% (p &gt; 0,05). En comparaci&#243;n a los valores pre ejercicio, el intervalo RR y la banda AF disminuyeron (cambios importantes: -69 &#177; 105 ms; -13 &#177; 14 un, respectivamente, p &lt; 0,01), mientras que la banda BF y la raz&#243;n BF/AF aumentaron (cambios importantes: -13 &#177; 14 un, +13 &#177; 14 un y +3 &#177; 3 un, respectivamente, p &lt; 0,01) tras la E70%.</p>
      <p><bold>CONCLUSI&#211;N:</bold> La mayor intensidad de ejercicio de fuerza para el tronco y miembros superiores produjo de modo agudo, un mayor incremento simpatovagal card&#237;aco post-ejercicio.</p>
      <p><bold>Palabras clave:</bold> Ejercicio, esfuerzo f&#237;sico, sistema nervioso aut&#243;nomo, sistema nervioso simp&#225;tico.</p>
      <p>
        <bold>Introducci&#243;n</bold>
      </p>
      <p>El ejercicio de fuerza es recomendado para individuos sanos<sup>1,2</sup> y con cardiopat&#237;as<sup>3</sup> debido a sus beneficios sobre la aptitud f&#237;sica<sup>4</sup>, la salud<sup>4</sup> y la calidad de vida<sup>5</sup>. Sin embargo, tras la realizaci&#243;n del ejercicio de fuerza, la modulaci&#243;n simp&#225;tica card&#237;aca sigue elevada, mientras que la modulaci&#243;n parasimp&#225;tica se mantiene reducida<sup>6-8</sup>, lo que puede aumentar el riesgo de ocurrencia de eventos cardiovasculares agudos<sup>9,10</sup>.</p>
      <p>Las instituciones de salud, tales como el <italic>American College of Sports Medicine</italic>, recomiendan que el programa de entrenamiento de fuerza se divida en dos sesiones: una con los ejercicios para los miembros inferiores y otra con ejercicios para los miembros superiores<sup>11</sup>. Un estudio reciente<sup>12</sup> mostr&#243; que realizar ejercicios solamente para los miembros mejora el aumento del balance simpatovagal card&#237;aco post-ejercicio. Sin embargo, el impacto de la realizaci&#243;n de ejercicios para la parte superior del cuerpo en estas respuestas no ha sido estudiado. Debido a que la respuesta cardiovascular al ejercicio de fuerza depende de la cantidad de masa muscular involucrada<sup>13</sup>, es posible que las respuestas auton&#243;micas despu&#233;s del ejercicio de tronco y miembros superiores sean diferentes, lo que hace necesario un an&#225;lisis.</p>
      <p>Otro aspecto importante es la sobrecarga durante el ejercicio de fuerza. En un estudio previo<sup>6</sup>, se evidenci&#243; que los dos protocolos de ejercicios de fuerza (10 repeticiones en el 80% de 1RM y 20 repeticiones en 40% de 1RM) causan alteraciones similares en la modulaci&#243;n auton&#243;mica card&#237;aca. Sin embargo, dado que los protocolos difieren tanto en el volumen (n&#250;mero de repeticiones) como en la intensidad (sobrecarga), no fue posible establecer claramente el impacto aislado de la intensidad del ejercicio de la modulaci&#243;n auton&#243;mica card&#237;aca despu&#233;s del ejercicio. Como la intensidad del ejercicio de fuerza afecta a las respuestas metab&#243;licas y mec&#225;nicas en la vasculatura, y por lo tanto en los mecanismos de reflejos de control cardiovascular, es posible que diferentes intensidades del ejercicio de fuerza promuevan diferentes respuestas en la modulaci&#243;n auton&#243;mica del coraz&#243;n post-ejercicio.</p>
      <p>De esta manera, analizar el efecto agudo de la intensidad del ejercicio de fuerza para el tronco y miembro superiores en la modulaci&#243;n auton&#243;mica del coraz&#243;n post-ejercicio ha sido el objeto de este estudio. Nuestra hip&#243;tesis es que el balance simpatovagal aumentar&#225; despu&#233;s del ejercicio de fuerza independientemente de la intensidad utilizada, adem&#225;s de una mayor magnitud y una mayor duraci&#243;n de esta respuesta que se observar&#225;n tras la sesi&#243;n de ejercicio con mayor intensidad.</p>
      <p>
        <bold>M&#233;todos</bold>
      </p>
      <p>
        <bold>Muestra</bold>
      </p>
      <p>Formaron parte de la muestra 15 varones, con edad entre 18 y 25 a&#241;os, reclutados en la universidad y comunidades locales. Antes de formar parte del estudio, se inform&#243; a los sujetos sobre todos los procedimientos a que ser&#237;an sometidos y, aquellos que concordaron con participar, firmaron el formulario de consentimiento informado. Este estudio fue aprobado por el Comit&#233; de &#201;tica en Investigaci&#243;n de la instituci&#243;n de los autores (223/08). Como criterios de inclusi&#243;n en el estudio, los individuos deber&#237;an ser eutr&#243;ficos, no presentar alguna enfermedad cardiovascular, no estar en uso de medicamento y, en los 06 meses antes del estudio, no ser practicantes de cualquier tipo de ejercicio f&#237;sico.</p>
      <p>
        <bold>Datos cl&#237;nicos</bold>
      </p>
      <p>Para la obtenci&#243;n de los datos cl&#237;nicos de los sujetos, se hizo una anamnesis que englobaba cuestiones sobre los factores de riesgo cardiovasculares. Con los datos registrados, los individuos fueron estratificados con relaci&#243;n al riesgo cardiovascular en alto, moderado o bajo<sup>1</sup>.</p>
      <p>Adem&#225;s de la anamnesis, medidas antropom&#233;tricas y de la presi&#243;n arterial se llevaron a cabo. La masa corporal y la estatura se midieron utilizando una balanza digital con precisi&#243;n de 0,1 kg (Filizola, Brasil) y un estadi&#243;metro de madera con precisi&#243;n de 0,1 cm, respectivamente. La presi&#243;n arterial se midi&#243; con el m&#233;todo auscultatorio con voluntarios sentados y en reposo, tres veces consecutivas, tras 05 minutos de reposo, en dos visitas diferentes<sup>14</sup>. Para permanecer en el estudio, los individuos deber&#237;an ser normotensos, presentando, por tanto, (y presentar) presi&#243;n arterial sist&#243;lica igual o inferior a 120 mmHg y diast&#243;lica igual o inferior a 80 mmHg<sup>14</sup>. La elecci&#243;n de este nivel de presi&#243;n arterial se debi&#243; a los sujetos con valores superiores ya tener alteraciones en el balance simpatovagal cardiaco<sup>15</sup>.</p>
      <p>Las caracter&#237;sticas cl&#237;nicas de los sujetos est&#225;n presentes en la <xref ref-type="table" rid="tab1-body3">Tabla 1</xref>.</p>
      <table-wrap id="tab1-body3">
        <graphic xlink:href="1678-4170-abc-96-06-0498-00043-gt01-es.jpg"/></table-wrap>
      <p>
        <bold>Sesiones de adaptaci&#243;n y prueba de una repetici&#243;n m&#225;xima (1-RM)</bold>
      </p>
      <p>Antes de las sesiones experimentales, cada individuo particip&#243; de dos sesiones de adaptaci&#243;n a los ejercicios de fuerza, realizadas en d&#237;as distintos. En cada sesi&#243;n de adaptaci&#243;n, los individuos realizaron tres series de 12 repeticiones con carga m&#237;nima permitida en los siguientes ejercicios: i) Supino Plano, ii) Remo curvo, iii) elevaci&#243;n frontal, iv) rosca directa y v) tr&#237;ceps frente. Todos los ejercicios incluidos en el estudio se llevaron a cabo con pesos libres.</p>
      <p>Dos d&#237;as tras la &#250;ltima sesi&#243;n de adaptaci&#243;n, los individuos realizaron la prueba de una repetici&#243;n m&#225;xima (1-RM)<sup>16</sup>. La prueba tuvo inicio con un calentamiento (10 repeticiones), con aproximadamente el 50% de la carga estimada para la primera tentativa, basado en la experiencia previa de los participantes. Acto seguido, se llevaron a cabo tres intentos con carga progresiva hasta identificarse la carga de 1-RM. Entre los intentos, y entre los ejercicios, se mantuvo un intervalo de recuperaci&#243;n de dos minutos. Con el objetivo de familiarizar los individuos a la prueba<sup>17</sup>, se llevaron a cabo 04 sesiones de pruebas de 1-RM, con intervalo m&#237;nimo de 48 horas entre las sesiones, donde la mayor carga encontrada durante la realizaci&#243;n de las pruebas se utiliz&#243; para calcular la intensidad del ejercicio en las sesiones experimentales.</p>
      <p>
        <bold>Protocolo experimental</bold>
      </p>
      <p>Tras la determinaci&#243;n de las cargas de 1-RM, los individuos se sometieron a tres sesiones experimentales: sesi&#243;n control (C), sesi&#243;n de ejercicio de fuerza con el 50% de 1-RM (E50%) y sesi&#243;n de ejercicio de fuerza con el 70% de 1-RM (E70%). La determinaci&#243;n del orden de las sesiones se hizo de forma aleatoria. Entre las sesiones, hubo un intervalo de menos tres d&#237;as como m&#237;nimo.</p>
      <p>Las sesiones se iniciaron en el mismo horario del d&#237;a. Se instruy&#243; a los sujetos que hicieran una refecci&#243;n leve 2 horas antes de los experimentos, evitaran ejercicios e ingirieran alcohol por al menos 48 horas de antelaci&#243;n, y de cafe&#237;na en las &#250;ltimas 12 horas, que durmiesen en horarios reglados y siguiesen con sus actividades diarias semejantes en las tres sesiones. Adem&#225;s de ello, las sesiones experimentales fueron marcadas en d&#237;as que los individuos presentaban rutinas semejantes.</p>
      <p>En cada sesi&#243;n experimental, al llegar al laboratorio, el individuo permaneci&#243; en reposo sentado por 10 minutos. Acto seguido, la frecuencia card&#237;aca se midi&#243; por 10 minutos continuos, por medio de un frecuenc&#237;metro (Polar, RS 800 CX, Estados Unidos). Tras las mediciones de reposo, el individuo se desplazaba hasta la sala de musculaci&#243;n donde eran realizadas las sesiones de ejercicio de fuerza o control.</p>
      <p>Las tres sesiones se conformaron por los 05 ejercicios descritos anteriormente, realizados en tres series consecutivas de 12, 09 y 06 repeticiones. En todas las sesiones (C, E50% y E70%), antes de cada ejercicio, una serie de calentamiento de 10 repeticiones se realiz&#243; utilizando el 25% de 1-RM. En la sesi&#243;n C, los sujetos realizaron los ejercicios con una barra de pl&#225;stico (0,1 kg) para asegurar que las diferencias encontradas en comparaci&#243;n con las sesiones de ejercicio (E50% y E70%) eran debidas a la intensidad empleada no al movimiento articular o a las alteraciones de postura. En las sesiones E50% y E70%, la carga de los ejercicios fue del 50% y el 70% de 1-RM, respectivamente. El intervalo de recuperaci&#243;n entre las series, y entre los ejercicios en todas las sesiones, fue de dos minutos.</p>
      <p>Tras la finalizaci&#243;n de las intervenciones, el individuo retornaba al laboratorio, donde permanec&#237;a en reposo sentado por 60 minutos m&#225;s (per&#237;odo pos intervencionista). La frecuencia card&#237;aca se obtuvo en intervalos de 10 minutos, entre los minutos 20 a 30 y 50 a 60 de la recuperaci&#243;n.</p>
      <p>
        <bold>An&#225;lisis de la variabilidad de la frecuencia card&#237;aca</bold>
      </p>
      <p>La modulaci&#243;n auton&#243;mica del sistema cardiovascular se obtuvo por medio de la t&#233;cnica de an&#225;lisis espectral de la variabilidad de la frecuencia card&#237;aca. Para tanto, se utilizaron los intervalos R-R obtenidos con el frecuenc&#237;metro (Polar, RS 800 CX, Estados Unidos). De esta manera, per&#237;odos estacionarios del tacograma, con al menos 500 latidos, se descompusieron en las bandas de baja (BF) y alta (AF) frecuencias por el m&#233;todo autorregresivo, utilizando el <italic>software</italic> Kubios HRV (Finlandia), de conformidad a las recomendaciones del <italic>Task Force</italic> de An&#225;lisis Espectral<sup>18</sup>. Se consideraron como fisiol&#243;gicamente significativas las frecuencias entre 0,04 y 0,4 Hz, siendo que el componente de BF fue representado por las oscilaciones entre 0,04 y 0,15 Hz y el de AF por las oscilaciones entre 0,15 y 0,4 Hz. El poder de cada componente espectral se normaliz&#243; con dividirse el poder de cada banda del espectro por la varianza total, de la cual se sustrajo el valor de banda de muy baja frecuencia (&lt; 0,04 Hz), siendo el resultado multiplicado por 100. Para la interpretaci&#243;n de los resultados, los componentes BF y AF normalizados de la variabilidad de la frecuencia card&#237;aca se tuvieron en cuenta, respectivamente, como representativos de la modulaci&#243;n predominantemente simp&#225;tica y parasimp&#225;tica del coraz&#243;n, y la raz&#243;n entre estas bandas (BF/AF), como el balance simpatovagal cardiaco<sup>18</sup>.</p>
      <p>
        <bold>An&#225;lisis estad&#237;stico</bold>
      </p>
      <p>La normalidad y la homogeneidad de varianza de los datos fueron confirmadas por las pruebas de Shapiro Wilks y de Levene, respectivamente. Los datos del per&#237;odo de pre-intervenci&#243;n en las tres sesiones experimentales se compararon por el an&#225;lisis de varianza (ANOVA) de un factor para mediciones repetidas. Las respuestas auton&#243;micas en cada sesi&#243;n experimental se calcularon por la diferencia entre los valores medidos pos y pre-intervenci&#243;n (&#916;= pos - pre). Las respuestas de la variabilidad de la frecuencia cardiaca tras las tres sesiones experimentales se compararon mediante la ANOVA de dos factores para mediciones repetidas, siendo considerados como factores principales la sesi&#243;n (C, E50% y E70%) y el tiempo (pre, 20-30 y 50-60 minutos). Cuando observado valor de F significante, se llev&#243; a cabo la prueba de <italic>post hoc</italic> de <italic>Newman-Keuls</italic>. El valor alfa de p &lt; 0,05 se consider&#243; como significante y los datos se presentan como media &#177; desviaci&#243;n est&#225;ndar.</p>
      <p>
        <bold>Resultados</bold>
      </p>
      <p>Todos los sujetos incluidos en el estudio presentaron riesgo cardiovascular bajo. De los 15 sujetos, tres de ellos iniciaron el protocolo con la sesi&#243;n C, 07 con E50% y 05 con E70%. Las pruebas de 1-RM y las cargas utilizadas durante las sesiones de ejercicio de fuerza est&#225;n presentadas en la <xref ref-type="table" rid="es_a11tab02-body3">Tabla 2</xref>.</p>
      <p content-type="asset">
        <table-wrap id="es_a11tab02-body3">
          <graphic xlink:href="1678-4170-abc-96-06-0498-00043-gt02-es.jpg"/></table-wrap>
      </p>
      <p>Los datos de la variabilidad de la frecuencia cardiaca antes de las intervenciones en las tres sesiones experimentales (C, E50% y E70%) est&#225;n presentados en la <xref ref-type="table" rid="es_a11tab03-body3">Tabla 3</xref>. Los valores pre ejercicio fueron semejantes entre las sesiones C, E50% y E70% (p &gt; 0,05).</p>
      <p content-type="asset">
        <table-wrap id="es_a11tab03-body3">
          <graphic xlink:href="1678-4170-abc-96-06-0498-00043-gt03-es.jpg"/></table-wrap>
      </p>
      <p>Las alteraciones en la modulaci&#243;n auton&#243;mica card&#237;aca tras las tres sesiones experimentales est&#225;n presentadas en la <xref ref-type="fig" rid="es_a11fig01-body3">Figura 1</xref>.</p>
      <p content-type="asset">
        <fig id="es_a11fig01-body3">
          <graphic xlink:href="1678-4170-abc-96-06-0498-00043-gf01-es.jpg"/></fig>
      </p>
      <p>En comparaci&#243;n con los valores pre intervenci&#243;n, el intervalo R-R aument&#243; tras la sesi&#243;n C, durante todo el per&#237;odo de recuperaci&#243;n (mayor aumento: +112 &#177; 83 ms, p &lt; 0,01), se mantuvo tras la sesi&#243;n E50%, durante todo el per&#237;odo de recuperaci&#243;n (p &gt; 0,05) y disminuy&#243; durante los 30 minutos iniciales de recuperaci&#243;n en la sesi&#243;n E70% (mayor reducci&#243;n: -69 &#177; 105 ms, p &lt; 0,01). As&#237;, el comportamiento del intervalo R-R, durante todo el per&#237;odo de recuperaci&#243;n, difiri&#243; significantemente entre las tres sesiones experimentales (p &lt; 0,05).</p>
      <p>En comparaci&#243;n a los valores pre intervenci&#243;n, la banda BF y la raz&#243;n BF/AF disminuyeron en la sesi&#243;n C (mayor reducci&#243;n: -10 &#177; 11 un.; -2 &#177; 2 respectivamente, p &lt; 0,01), se mantuvieron en la sesi&#243;n E50% (p &gt; 0,05) y aumentaron en la sesi&#243;n E70% (mayor aumento: +13 &#177; 14 un.; +3 &#177; 3, respectivamente, p &lt; 0,01). As&#237;, el comportamiento de estas variables, durante todo el per&#237;odo de recuperaci&#243;n, difiri&#243; significantemente entre las tres sesiones experimentales (p &lt; 0,05).</p>
      <p>Comparando los valores de la pre intervenci&#243;n, la banda de AF aument&#243; en la sesi&#243;n C (mayor aumento: +10 &#177; 11 un., p &lt; 0,01), se mantuvo en la sesi&#243;n E50% (p &gt; 0,05) y se redujo en la sesi&#243;n E70%, en todo per&#237;odo de recuperaci&#243;n (mayor reducci&#243;n: -13 &#177; 14 un., p &lt; 0,01). As&#237;, el comportamiento de la banda AF, durante todo el per&#237;odo de recuperaci&#243;n, difiri&#243; significantemente entre las tres sesiones experimentales (p &lt; 0,05).</p>
      <p>Comparando los valores de la pre intervenci&#243;n, el poder total aument&#243; solamente en la sesi&#243;n C (mayor aumento: +4.227 &#177; 4.328 ms<sup>2</sup>, p &lt; 0,01) y se mantuvo en las sesiones E50% y E70%, durante todo el per&#237;odo de recuperaci&#243;n. As&#237;, el comportamiento de esta variable, en todo el per&#237;odo de recuperaci&#243;n, fue diferente entre la sesi&#243;n C y las sesiones E50% y E70%.</p>
      <p>
        <bold>Discusi&#243;n</bold>
      </p>
      <p>Los resultados de este estudio han demostrado que el ejercicio de fuerza para tronco y miembros superiores produce un aumento de la modulaci&#243;n simp&#225;tica card&#237;aca y reducci&#243;n de la modulaci&#243;n parasimp&#225;tica card&#237;aca. Adem&#225;s de ello, esta alteraci&#243;n de la modulaci&#243;n auton&#243;mica card&#237;aca fue mayor tras del ejercicio de fuerza m&#225;s intenso.</p>
      <p>Durante 60 minutos tras la sesi&#243;n E70%, se evidenci&#243; aumento de la modulaci&#243;n simp&#225;tica y reducci&#243;n de la modulaci&#243;n parasimp&#225;tica card&#237;aca. Estos resultados son semejantes a los observados en estudios anteriores que emplean el ejercicio de fuerza para las principales agrupaciones musculares<sup>6,8</sup> o para los miembros inferiores<sup>12</sup>. Estos resultados sugieren que independientemente de los ejercicios empleados (principales agrupaciones musculares, miembros inferiores o tronco y miembros superiores), la realizaci&#243;n del ejercicio de fuerza produce alteraciones en la modulaci&#243;n auton&#243;mica card&#237;aca, que permanecen por un largo per&#237;odo tras la finalizaci&#243;n de la sesi&#243;n.</p>
      <p>Los mecanismos implicados en esta respuesta no se estudiaron en el presente estudio. Sin embargo, es posible que en la sesi&#243;n control el estr&#233;s ortost&#225;tico, ocasionado por el per&#237;odo prolongado en la posici&#243;n sentada, promueva reducci&#243;n del retorno venoso y aumento de la actividad nerviosa simp&#225;tica perif&#233;rica, estimulando el barorreflejo<sup>19,20</sup>. Este est&#237;mulo, por su vez, promueve la disminuci&#243;n de la actividad nerviosa simp&#225;tica y aumento de la actividad parasimp&#225;tica card&#237;acas<sup>21</sup>. Por otro lado, en la sesi&#243;n de ejercicio de fuerza, posiblemente ocurre mayor reducci&#243;n del retorno venoso, desactivando los receptores cardiopulmonares<sup>6</sup>, una vez que, tras estas sesiones, no se observ&#243; hipotensi&#243;n post ejercicio<sup>21</sup>. Adem&#225;s de esto, el estr&#233;s ortost&#225;tico parece potencializar dicha respuesta, una vez que la recuperaci&#243;n de la frecuencia card&#237;aca en la posici&#243;n sentada parece ser m&#225;s prolongada en comparaci&#243;n a la posici&#243;n supina<sup>22</sup>.</p>
      <p>En el presente estudio, comparado al ejercicio de fuerza llevado a cabo a un 50% de 1-RM, el ejercicio de fuerza llevado a cabo con un 70% de 1-RM produjo un mayor aumento de la modulaci&#243;n auton&#243;mica simp&#225;tica card&#237;aca. Estos resultados son diferentes de los observados por Rezk et al<sup>6</sup>, que verificaron alteraci&#243;n semejante en la modulaci&#243;n auton&#243;mica card&#237;aca tras la realizaci&#243;n del ejercicio de fuerza con el 80% de 1-RM y con el 40% de 1-RM hasta la fatigax Esta controversia fue posiblemente ocasionada por la variaci&#243;n del n&#250;mero de repeticiones entre las intensidades en el estudio de Rezk et al<sup>6</sup>, lo que no ha ocurrido en el presente estudio. Estos resultados se&#241;alan que el aumento de la modulaci&#243;n simp&#225;tica card&#237;aca post ejercicio de fuerza es dependiente de la intensidad del ejercicio, desde que el n&#250;mero de repeticiones llevadas a cabo sea el mismo.</p>
      <p>Con relaci&#243;n a la duraci&#243;n de las alteraciones auton&#243;micas card&#237;acas tras el ejercicio de fuerza, Rezk et al<sup>6</sup> evidenciaron que, 75 minutos tras el ejercicio de fuerza, la modulaci&#243;n auton&#243;mica simp&#225;tica card&#237;aca sigue elevada. Estos resultados son semejantes a los observados en la sesi&#243;n E70% del presente estudio, en que las alteraciones en la modulaci&#243;n auton&#243;mica se lleven a cabo hasta los 60 minutos de recuperaci&#243;n. Por otro lado, en la sesi&#243;n E50%, los valores de la modulaci&#243;n auton&#243;mica card&#237;aca en los 60 minutos post ejercicio fueron similares a los de reposo. Teniendo en cuenta que en la E70% los individuos se acercaban mucho a la fatiga en cada serie, lo que no ocurr&#237;a en la E50%, es posible sugerir que la realizaci&#243;n de los ejercicios de fuerza hasta pr&#243;ximo a la fatiga resulte en una mayor y m&#225;s duradera activaci&#243;n simp&#225;tica card&#237;aca<sup>9,10</sup>. Esta respuesta posiblemente est&#225; relacionada a una mayor sobrecarga mec&#225;nica del sistema vascular en el ejercicio de mayor intensidad, que promueve mayor activaci&#243;n de los mecanorreceptores<sup>23</sup> y la mayor activaci&#243;n del metaborreflejo resultante de la reducci&#243;n del flujo sangu&#237;neo<sup>12</sup>. Otro posible mecanismo es la mayor reducci&#243;n del volumen plasm&#225;tico, tras el ejercicio de fuerza con la mayor intensidad, debido al desborde de sangre al espacio intersticial, produciendo as&#237; una reducci&#243;n del retorno venoso. Esto, a su vez, resultar&#237;a en la desactivaci&#243;n de los receptores cardiopulmonares, y en el consecuente aumento de la frecuencia card&#237;aca. No obstante, se hace necesario probar estas hip&#243;tesis.Los resultados de este estudio presentan aplicaciones pr&#225;cticas importantes. El aumento de la modulaci&#243;n simp&#225;tica y la reducci&#243;n de la modulaci&#243;n parasimp&#225;tica cardiacas est&#225;n relacionados con el aumento del riesgo cardiovascular<sup>9,10</sup>. As&#237;, es posible sugerir que el ejercicio de fuerza para tronco y miembros superiores con el 70% de 1-RM produzca un transiente alterado en la modulaci&#243;n auton&#243;mica card&#237;aca, que puede representar un aumento en el riesgo cardiovascular, lo que no ocurre cuando utilizado el 50% de 1-RM. De esta forma, la prescripci&#243;n del ejercicio de fuerza con el 50% de 1-RM puede ser una importante estrategia para minimizar el riesgo en aquellos individuos que presentan mayor riesgo cardiovascular. Sin embargo, se hace necesario confirmar esta hip&#243;tesis en estudios futuros.</p>
      <p>Este estudio presenta limitaciones que se deben tener en cuenta. No hubo control sobre la frecuencia respiratoria de los individuos en ning&#250;n de los momentos de las sesiones experimentales. De esta forma, es posible que los movimientos respiratorios puedan ter influenciado en el poder de la banda de alta frecuencia. Los sujetos en el presente estudio eran j&#243;venes y sanos y la extrapolaci&#243;n de los resultados para individuos con otras caracter&#237;sticas es limitada. No obstante, teniendo en cuenta la escasez de datos acerca de ese tema en la literatura, los resultados de este estudio suministran indicativos iniciales sobre el impacto del ejercicio de fuerza en la modulaci&#243;n auton&#243;mica card&#237;aca.</p>
      <p>Finalmente, aunque se ha aleatorizado el orden de realizaci&#243;n de las sesiones, dicha aleatorizaci&#243;n result&#243; en una distribuci&#243;n no balanceada entre las sesiones. Sin embargo, nos parece que la probabilidad de este factor haber impactado considerablemente los resultados sea m&#237;nima.</p>
      <p>
        <bold>Conclusi&#243;n</bold>
      </p>
      <p>Tras una sesi&#243;n aguda de ejercicio de fuerza para tronco y miembros superiores, ocurre aumento en la modulaci&#243;n simp&#225;tica y reducci&#243;n de la modulaci&#243;n parasimp&#225;tica card&#237;aca. Estas respuestas se acent&#250;an m&#225;s en la sesi&#243;n con mayor intensidad.</p>
      <p>
        <bold>Potencial Conflicto de Intereses</bold>
      </p>
      <p>Declaro no haber conflicto de intereses pertinentes.</p>
      <p>
        <bold>Fuentes de Financiaci&#243;n</bold>
      </p>
      <p><italic>Funda&#231;&#227;o de Amparo a Ci&#234;ncia e Tecnologia do Estado de Pernambuco</italic> (FACEPE); <italic>Programa de Fortalecimento Acad&#234;mico da Universidade de Pernambuco</italic> (PFA-UPE); <italic>Conselho Nacional de Desenvolvimento Cient&#237;fico e Tecnol&#243;gico</italic> (CNPq) financiaron el presente estudio.</p>
      <p>
        <bold>Vinculaci&#243;n Acad&#233;mica</bold>
      </p>
      <p>No hay vinculaci&#243;n de este estudio a programas de post grado.</p>
      <p>
        <bold>Referencias</bold>
      </p>
    </body>
  </sub-article>
</article>
