Adaptações cardiovasculares e inflamatórias ao treinamento físico em indivíduos hipertensos

INTRODUÇÃO: A hipertensão arterial sistêmica está intimamente relacionada à prevalência de doenças cardiovasculares, desempenhando papel crucial na fisiopatologia e progressão da doença aterosclerótica. Fatores de risco ambientais como obesidade, sedentarismo e maus hábitos alimentares, aceleram o curso da doença levando a disfunção dos mecanismos de controle da pressão arterial. Recentemente, a participação de fatores inflamatórios na etiologia da hipertensão arterial tem sido alvo de investigação, demonstrando estreita relação com o comprometimento da função endotelial. A promoção do estilo de vida ativo através de estratégias de treinamento físico é endossada como uma alternativa não medicamentosa eficiente no controle e prevenção da hipertensão e disfunção endotelial. Contudo, ainda não está claro como a função endotelial, inflamação e a pressão arterial se relacionam frente ao treinamento aeróbico e o treinamento de força. OBJETIVO: O presente estudo teve como objetivo investigar o efeito de doze semanas de dois tipos de treinamento físico, aeróbico e de força, sobre as adaptações inflamatórias, endoteliais e da pressão arterial de indivíduos hipertensos de meia idade através de um ensaio clínico randomizado controlado. MÉTODOS: 42 pacientes hipertensos medicados (19 homens/23 mulheres; 30 a 59 anos de idade) foram distribuídos de forma randomizada entre uma das seguintes intervenções: treinamento aeróbico supervisionado (n=15), treinamento de força supervisionado (n=15) ou grupo controle sem exercícios (n=12). Antes e após a intervenção (12 semanas) foram avaliados os seguintes desfechos: perfil inflamatório, função endotelial e pressão arterial ambulatorial. RESULTADOS: Ambas as intervenções, treinamento aeróbico e de força reduziram a pressão arterial sistólica durante o dia (-7,2±7,9 and -4,4±5.8 mmHg; p<0,05) e a média de 24-h (-5,6±6,2 and -3,2±6,4 mmHg; p<0,05). Ambas as estratégias foram eficientes em aumentar vasodilatação mediada pelo fluxo (exercício aeróbico: 1,7±2,8%; exercício de força: 1,4±2,6%). Entretanto, somente o treinamento aeróbico reduziu a concentração plasmática dos marcadores inflamatórios (CRP, MCP-1, VCAM-1 e LOX-1), endotelina-1 e aumentou a concentração de NOx (p<0,05). CONCLUSÃO: Os profissionais de saúde devem enfatizar o exercício aeróbico para o controle da hipertensão, dado o papel estabelecido do óxido nítrico, endotelina-1 e inflamação crônica de baixo nível na patogênese das doenças cardiovasculares. No entanto, foi demonstrado neste estudo que o treinamento de força também deve ser incentivado para pacientes hipertensos de meia-idade. Estes resultados sugerem que, mesmo que os pacientes estejam tomando medicamentos anti-hipertensivos, exercícios regulares são benéficos para o controle da pressão arterial e redução do risco de doença cardiovascular.INTRODUCTION: The benefits of aerobic training (AT) on inflammation, endothelial function and blood pressure in hypertensive individuals are widely accepted, but the effects of resistance training (RT) are less clear. OBJECTIVE: This randomized controlled trial tested the hypothesis that both aerobic training (AT) and dynamic resistance training (RT) will improve inflammation, endothelial function and 24-h ambulatory blood pressure (ABP) in middle-aged adults with hypertension, but aerobic training would be more effective. METHODS: Forty-two hypertensive patients on at least one antihypertensive medication (19 males/23 females; 30 to 59 years of age) were randomly assigned to 12 weeks of supervised AT (n=15), RT (n=15) or a non-exercise control (n=12) group. Inflammation, endothelial function, 24-h ABP and related measures were evaluated at pre- and post-intervention. RESULTS: We found that AT and RT were well tolerated. Both AT and RT reduced daytime systolic ABP (-7.2±7.9 and -4.4±5.8 mmHg; p<0.05) and 24-h systolic ABP (- 5.6±6.2 and -3.2±6.4 mmHg; p<0.05). AT and RT both improved brachial artery flowmediated dilation by 1.7±2.8 and 1.4±2.6 %, respectively (7.59±3.36 vs. 9.26±2.93 and 7.24±3.18 vs. 8.58±2.37; pre vs. post p<0.05). However, only AT decreased markers of inflammation (CRP, MCP-1, VCAM-1 and LOX-1) and endothelin-1 and increased NOx levels (p<0.05). CONCLUSION: health care providers should continue to emphasize AT for hypertension management given the established role of nitric oxide, endothelin-1 and chronic low level inflammation in the pathogenesis of cardiovascular disease. However, our study demonstrates that RT should also be encouraged for middleaged hypertensive patients. Our results also suggest that even if patients are on antihypertensive medications, regular AT and RT are beneficial for blood pressure control and cardiovascular disease risk reduction

Predictive equations for evaluation for resting energy expenditure in Brazilian patients with type 2 diabetes : what can we use?

Background: Evaluation of the resting energy expenditure (REE) is essential to ensure an appropriate dietary prescription for patients with type 2 diabetes. The aim of this record was to evaluate the accuracy of predictive equations for REE estimation in patients with type 2 diabetes, considering indirect calorimetry (IC) as the reference method. Methods: A cross-sectional study was performed in outpatients with type 2 diabetes. Clinical, body composition by electrical bioimpedance and laboratory variables were evaluated. The REE was measured by IC (QUARK RMR, Cosmed, Rome, Italy) and estimated by eleven predictive equations. Data were analyzed using Bland–Altman plots, paired t-tests, and Pearson’s correlation coefficients. Results: Sixty-two patients were evaluated [50% female; mean age 63.1 ± 5.2 years; diabetes duration of 11 (1–36) years, and mean A1C of 7.6 ± 1.2%]. There was a wide variation in the accuracy of REE values predicted by equations when compared to IC REE measurement. In all patients, Ikeda and Mifflin St-Jeor equations were that most underestimated REE. And, the equations that overestimated the REE were proposed by Dietary Reference Intakes and Huang. The most accurate equations were FAO/WHO/UNO in women (− 1.8% difference) and Oxford in men (− 1.3% difference). Conclusion: In patients with type 2 diabetes, in the absence of IC, FAO/WHO/UNO and Oxford equations provide the best REE prediction in comparison to measured REE for women and men, respectively

Effects of exercise modalities on decreased blood pressure in patients with hypertension

This study aimed to evaluate the acute effects of aerobic and resistance exercises on blood pressure and endothelial blood markers. We also correlated post-exercise blood pressure response with baseline cardiovascular parameters in middle-aged patients with hypertension. This cross-sectional study randomized 54 volunteers into the aerobic exercise group (AG, n = 27; 45.6 ± 7.7 years) or dynamic resistance exercise group (RG, n = 27; 45.8 ± 8.4 years). Blood marker evaluation, cardiopulmonary exercise tests, resting blood pressure monitoring, ambulatory blood pressure monitoring (ABPM), flow-mediated dilatation monitoring, and body composition evaluation were carried out. Exercise sessions were performed to evaluate post-exercise hypotension (PEH) and endothelial marker responses, in addition to post-exercise ABPM (ABPMex). This study is an arm of the study which was approved by the local ethics committee (No. 69373217.3.0000.5347) in accordance with the Helsinki Declaration and was registered at ClinicalTrials. gov (NCT03282942). The AG performed walking/running at 60% of the reserve heart rate, while the RG performed 10 exercises with two sets of 15–20 repetitions. The mean 24 h ABPM and ABPMex values showed no significant statistical differences. Systolic and diastolic blood pressure hypotension after aerobic and dynamic resistance were −10.59 ± 5.24/−6. 15 ± 6.41 mmHg and −5.56 ± 7.61/−6.20 ± 8.25 mmHg, respectively. For an up-to-7 h assessment of resting pressure, there was a positive effect in the aerobic group. The concentrations of nitrites/nitrates (NOx) and endothelin-1 (ET-1) did not change during hypotension. Moreover, PEH and ABPMex were significantly correlated with baseline health variables. Thus, when middle-aged patients with hypertension perform aerobic or resistance exercise, the NOx/ET1 pathway does not provide the best explanation for PEH. Finally, we found associations between baseline cardiovascular variables and endothelial vasoconstrictors with PEH

Effects of high-intensity interval training combined with traditional strength or power training on functionality and physical fitness in healthy older men : a randomized controlled trial

Concurrent training (CT) is an efficient strategy to improve neuromuscular function and cardiorespiratory fitness in older adults, which are factors of pivotal importance for the maintenance of functional capacity with aging. However, there is a lack of evidence about the effectiveness of power training (PT) as an alternative to traditional strength training (TST) during CT. Thus, the aim of the present study was to examine the effect of 16 weeks (twice weekly) TST combined with high intensity interval training (TST + HIIT) vs. PT combined with HIIT (PT + HIIT) on functional performance, cardiorespiratory fitness and body composition in older men. Thirty five older men (65.8 ± 3.9 years) were randomly allocated into two training groups: TST + HIIT (n = 18), and PT + HIIT (n = 17). TST + HIIT performed resistance training at intensities ranging from 65% to 80% 1RM at slow controlled speed (≅ 2 s for each concentric phase), whereas PT + HIIT trained at intensities ranging from 40% to 60% of 1RM at maximal intentional speed. Both groups performed HIIT at intensities ranging from 75 to 90% of VO2peak. Participants performed functional tests (sit-to-stand, timed-up-and-go, stair climbing); cardiopulmonary exercise testing (maximal cycling power output: Wmax, peak oxygen uptake: VO2peak, cycling economy), as well as body composition assessment (DXA) before, post 8 and post 16 weeks of training. The groups improved similarly (P < 0.05) with training in all functional capacity outcomes, Wmax, cycling economy, VO2peak and body composition (P < 0.05). These findings suggest that HIIT based CT programs involving TST vs. PT are equally effective in improving functionality, cardiorespiratory fitness and body composition in healthy older men

Relationship between insulin resistance and adipocytokines: the mediator role of adiposity in children

Background: Leptin and adiponectin interact with each other in the modulation of obesity and insulin resistance (IR) and it is also important to consider the role of cardiorespiratory and muscular fitness in these relationships. Aim: To analyse the relationship between IR with adipocytokines in children, and to test the mediation effect of %BF (percentage of body fat) in the association of IR with leptin, adiponectin, and L/A ratio. Subjects and methods: This cross-sectional study comprised a sample of 150 schoolchildren, aged 6–11 years, from school in Porto Alegre, Brazil. The following variables were evaluated: cardiorespiratory fitness (CRF), muscular fitness (MF), percentage of body fat (%BF), and biochemical variables (leptin, adiponectin, glucose, and insulin). Results: IR was associated with leptin and L/A ratio, after adjustments for age, sex, sexual maturation, and CRF. When adjusted for age, sex, sexual maturation, and MF, an association was found between IR with leptin and L/A ratio. Moreover, %BF was a mediator in the association between IR and leptin, as well as IR and L/A ratio, explaining 54% and 57% of these associations, respectively. Conclusion: Leptin and L/A ratio are positively associated with IR after adjustments. Also, %BF is a mediator in the associations between IR and leptin and L/A ratio

Cardiometabolic health profle of young girls with aesthetic professions

Background: In the literature, professions that impose body standards for daily performance are designated as nonconventional professions (i.e. models, athletes, ballet dancers), with great emphasis on the female population. More than a job, it becomes a lifestyle to those inserted in this environment, thus, thousands of children and adolescents seek inclusion and success in these professions due to fnancial and media gains. Such professions are associated with several health-related risk factors. The purpose of this study was to identify and compare among physical ftness levels, cardiometabolic health markers, mental health and dietary habits in non-conventional professions. Methods: The sample consisted of 41 female individuals aged between 14 and 24 years, allocated into four groups, control group composed by university students (UG=11), models (MG=11), ballet dancers (BG=11), and athletes’ group (AG=8). Physical ftness outcomes (cardiorespiratory ftness, fexibility, maximal dynamic strength, muscular endurance and body composition); biochemical outcomes (high-density lipoprotein [HDL], low-density lipoprotein [LDL], total cholesterol [TC], fasting glucose [FG], fasting insulin [FI], C-reactive protein [CRP]), diet quality and mental health were evaluated. Results: No impairments were observed in the health markers evaluated among groups, both for health-related physical ftness and biochemical outcomes. However, low levels of bone mineral density (BMD) were observed. Even with statistically signifcant diferences between the groups for chronological age (p=0.002), menarche (p=0.004), career length (p=0.001), height (p=0.001), body mass index (p=0.018), waist-to-height ratio (p<0.001), %Fat (p=0.020), VO2peak (p=0.020), maximal dynamic strength of knee extensors (p=0.031) and elbow fexors (p=0,001) and fexibility (p<0.001), all these values are within the normal range for health. Conclusion: The professions analyzed do not seem to interfere in the physical ftness and cardiometabolic health of the girls assessed. However, we identifed that exposure to these profession can impair mental health (depressive symptoms in 100% of participants) and body composition (BMD 63% of participants)