Health behaviour change in cardiovascular disease prevention and management : meta-review of behaviour change techniques to affect self-regulation

Self-regulation processes assume a major role in health behaviour theory and are postulated as important mechanisms of action in behavioural interventions to improve health prevention and management. The need to better understand mechanisms of behaviour change interventions for cardiovascular diseases (CVD) called for conducting a meta-review of meta-analyses for interventions targeting self-regulation processes. The protocol, preregistered on Open Science Framework (OSF), found 15 eligible meta-analyses, published between 2006 and August 2019, which quantitatively assessed the role of self-regulatory mechanisms and behaviour change techniques (BCTs). Quality of the meta-analyses varied widely according to AMSTAR-2 criteria. Several BCTs, assumed to engage self-regulatory mechanisms, were unevenly represented in CVD meta-analytic reviews. Self-monitoring, the most frequently studied self-regulatory BCT, seemed to improve health behaviour change and health outcomes but these results merit cautious interpretation. Findings for other self-regulatory BCTs were less promising. No studies in the CVD domain directly tested engagement of self-regulation processes. A general challenge for this area stems from reliance on post-hoc tests of the effects of BCTs in multiple-component interventions. Recent advances in BCT taxonomies and the experimental medicine approach to engaging self-regulation mechanisms, however, provide opportunities to improve CVD prevention and management behavioural interventions

Isometric exercise training and arterial hypertension: an updated review

Hypertension is recognised as a leading attributable risk factor for cardiovascular disease and premature mortality. Global initiatives towards the prevention and treatment of arterial hypertension are centered around non-pharmacological lifestyle modification. Exercise recommendations differ between professional and scientific organisations, but are generally unanimous on the primary role of traditional aerobic and dynamic resistance exercise. In recent years, isometric exercise training (IET) has emerged as an effective novel exercise intervention with consistent evidence of reductions in blood pressure (BP) superior to that reported from traditional guideline recommended exercise modes. Despite a wealth of emerging new data and endorsement by select governing bodies, IET remains under utilised and is not widely prescribed in clinical practice. This expert-informed review critically examines the role of IET as a potential adjuvant tool in the future clinical management of BP. We explore the efficacy, prescription protocols, evidence quality and certainty, acute cardiovascular stimulus, and physiological mechanisms underpinning its anti-hypertensive effects. We end the review with take-home suggestions regarding the direction of future IET research

Associação dos fatores de risco para doenças cardiovasculares e qualidade de vida entre servidores da saúde Association of cardiovascular disease risk factors and quality of life among health workers

Inúmeros problemas de saúde pública são atribuídos aos fatores induzidos pelo ambiente de trabalho que, associados ao estilo de vida sedentário, contribuem para deteriorar a qualidade de vida do trabalhador. Neste sentido, procuramos descrever o perfil, avaliar a condição física e o risco cardiovasculares dos funcionários da saúde. Foram avaliados 198 funcionários (46 ± 10 anos) que responderam uma anamnese e foram submetidos a avaliações bioquímicas, antropométricas e funcionais. Os valores foram apresentados como média ± desvio padrão da média. Foram utilizados testes de qui-quadrado (x²), taxa de "odds" e correlações de Pearson (p < 0,05). Dos avaliados, 54% apresentaram peso corporal elevado, 33% pressão arterial (PA) elevada e 56% eram sedentários. Colesterol total (CT), lipoproteína de baixa densidade e triglicerídeos (TG) acima da normalidade foram encontrados em 49%, 41% e 24% dos servidores, respectivamente e, 75% apresentaram taxas reduzidas de lipoproteína de alta densidade. As análises de x² e taxa de "odds" apontaram que os valores de TG e PA foram significativamente maiores para homens comparados às mulheres. Capacidade cardiorrespiratória ruim foi verificada em 56% dos homens e 23% das mulheres, além disso, a flexibilidade apresentou-se com níveis insatisfatórios para homens e mulheres. Observou-se que o índice de massa corporal se correlacionou positivamente com PA, CT e TG. Constatou-se, também que a idade foi fator agravante para PA, flexibilidade, CT e glicemia nas mulheres. Dessa forma, a prevalência de múltiplos fatores de risco nestes trabalhadores demonstra tratar-se de população não assistida pela saúde, motivo pelo qual sugere-se conscientização sobre sua própria saúde evitando a aposentadoria precoce<br>Several public health problems are due to environmental work, which, associated with sedentarism, contribute to reduce the quality of life of the worker. Therefore, this study aimed to describe the profile, evaluate the physical condition and cardiovascular risk factor of health workers. Health workers (198) from Bauru and Jau cities (46 ± 10 years old) were assessed. They answered a questionnaire and participated in antrophometric and functional assessments. Values are presented as means ± SD. Qui-squared (x²) analysis, odds rate and Pearson correlation were used (p < 0.05). From all workers evaluated, 54% presented high body weight, 33% high blood pressure and 56% were sedentary. Total cholesterol (TC), low-density lipoprotein and triglycerides (TG) above normal values were found in 49%, 41% and 24% of the individuals, respectively, and 75% presented low values of high-density lipoprotein. Qui-squared analysis and odds rate confirmed that TG and blood pressure (BP) were higher for men compared with women. Physical capacity was bad for 56% of men and 23% of women. Also, flexibility was unsatisfactory for men and women. Body mass index correlated positively with BP, TC and TG. Aging was an important risk factor for BP, TC, blood glucose, body mass index and flexibility only for women (p < 0.05). The prevalence of multiple risk factors among these health workers shows that this population is not adequately assisted. For this reason, a program from the government in order to make this population recognize such problems and avoid premature retirement is suggeste

Efeito do exercício aeróbico e resistido no controle autonômico e nas variáveis hemodinâmicas de jovens saudáveis Effect of resistance and aerobic exercise on the autonomic control and hemodynamic variables in health young individuals

A prática de exercícios aeróbicos e resistidos provoca ajustes agudos e crônicos distintos. Já foram documentadas diferenças hemodinâmicas e musculares entre os exercícios; todavia, quanto aos ajustes autonômicos, os estudos são escassos e controversos. O objetivo deste estudo foi analisar as adaptações hemodinâmicas e autonômicas após uma sessão de exercício aeróbico (30 minutos, bicicleta ergométrica) e resistido (três séries de 12 repetições para os principais grupamentos musculares), em indivíduos jovens e saudáveis. Para tanto, utilizamos medidas da pressão arterial (PA), frequência cardíaca (FC), cálculo do duplo produto e análise da variabilidade da FC (VFC) nos domínios do tempo e da frequência e a Plotagem de Poincaré. Neste protocolo, a FC durante o exercício aeróbico foi maior do que no resistido (153,32 ± 2,76 vs. 143,10 ± 3,38 bpm, respectivamente). O exercício aeróbico gerou aumento da PA sistólica durante o exercício (7,25 ± 1,97 mmHg). Já o exercício resistido provocou aumento tanto da PA sistólica quanto da diastólica durante sua execução (14,83 ± 1,53; 11,92 ± 1,69 mmHg, respectivamente). Não foi observada hipotensão pós-exercício para nenhuma das sessões. Ao comparar o exercício aeróbico com o resistido na fase de recuperação, verificamos diminuição na VFC no resistido nas variáveis: RMSSD (37,74 ± 5,30 vs. 19,50 ± 2,32), NN50 (94,13 ± 23,65 vs. 27,63 ± 6,68), PNN50 (16,10 ± 4,72 vs. 3,53 ± 0,89), SD1 (26,65 ± 3,85 vs. 13,73 ± 1,66), SD2 (88,98 ± 10,71 vs. 61,88 ± 5,49) e HF (257,25 ± 45,08 vs. 102,75 ± 18,75 ms²). Concluiu-se que, para os protocolos investigados, o trabalho cardiovascular durante o exercício foi semelhante, resultando principalmente do aumento da FC no exercício aeróbico e do aumento da PAS no resistido. No período de recuperação, o exercício resistido promoveu maior alteração autonômica, compatível com manutenção do balanço simpatovagal aumentado.<br>The practice of aerobic and resistance exercises provokes distinct acute and chronic adjustments. Hemodynamic and muscular differences between both exercises have been already documented; nevertheless, regarding the autonomic adjustments, there are few and controversial studies. Therefore, the aim of this study was to analyze the hemodynamic and autonomic adaptations after one bout of aerobic exercise (30 minutes, ergometric bicycle) and resistance exercise (three series of 12 repetitions to the main muscle groups), in young and healthy individuals. For this purpose, blood pressure (BP) and heart rate (HR) were measured, as well as the calculation of the double product and analysis of heart rate variability in time and frequency domains and by Poincaré's Plot. In this protocol, HR during the aerobic exercise was higher than in the resistance exercise (153.32 ± 2.76 vs. 143.10 ± 3.38 bpm, respectively). Aerobic exercise caused an increase in systolic BP during the exercise (7.25 ± 1.52 mmHg) whereas resistance exercise provoked an increase in both, systolic and diastolic BP during its execution (14.83 ± 1.53; 11.92 ± 1.69 mmHg, respectively). Post-exercise hypotension was not observed after none of the exercise sessions. When comparing aerobic exercise with resistance exercise in the recovery phase, it was verified a decrease in HR variability in the resistance session for the following variables: RMMSD (37.74 ± 5.30 vs. 19.50 ± 2.32), NN50 (94.13 ± 23.65 vs. 27.63 ± 6.68), PNN50 (16.10 ± 4.72 vs. 3.53±0.89), SD1 (26.65 ± 3.85 vs. 13.73 ± 1.66), SD2 (88.98 ± 10.71 vs. 61.88 ± 5.49) e HF (257.25 ± 45.08 vs. 102.75 ± 18.75 ms²). In conclusion, in the investigated protocol, the cardiovascular work during the exercise sessions was similar, due to HR increase in the aerobic exercise and of systolic BP increase in the resistance exercise. In the recovery phase, resistance exercise promoted enhanced autonomic alteration, compatible with the maintenance if an increased sympatho-vagal balance