Efeitos do exercício intradialítico sobre a qualidade do sono e a modulação autonômica cardíaca / Effects of intradialytic exercise on sleep quality and cardiac autonomic modulation / Efectos del ejercicio intradialítico sobre la calidad del sueño y la modulación autonómica cardíaca

Objetivo: avaliar os efeitos de um programa de exercício resistido intradialítico sobre a qualidade do sono e a modulação autonômica cardíaca de pacientes em hemodiálise. Método: ensaio clínico não randomizado, realizado entre fevereiro de 2019 e outubro de 2020, com 52 indivíduos renais crônicos dialíticos, alocados em grupo intervenção (GI; n=32) e grupo controle (GC; n=20). O GI realizou 12 semanas de treinamento físico intradialítico, três vezes por semana. Foram mensurados índices de qualidade do sono e modulação autonômica cardíaca. Resultados: houve incremento nos índices desvio padrão dos intervalos batimento a batimento (SDNN) (ms) (p=0,0004), raiz quadrada da média do quadrado dos intervalos batimento a batimento adjacentes (RMSSD) (ms) (p<0,0001), desvio padrão 1 (SD1) (ms) (p=0,03) e razão desvio padrão 1/desvio padrão 2 (SD1/SD2) (p=0,0003). Não houve melhora da qualidade do sono. Conclusão: O exercício resistido intradialítico, é capaz de melhorar a modulação autonômica cardíaca em pacientes com doença renal crônica

Objective: to evaluate the effects of an intradialytic resistance exercise program on sleep quality and cardiac autonomic modulation in hemodialysis patients. Method: non-randomized clinical trial, carried out between February 2019 and October 2020, with 52 individuals with chronic renal failure on dialysis, divided into an intervention group (IG; n=32) and a control group (CG; n=20). The IG performed 12 weeks of intradialytic physical training, three times a week. Indices of sleep quality and cardiac autonomic modulation were measured. Results: there was an increase in the standard deviation indices of beat-to-beat intervals (SDNN) (ms) (p=0.0004), square root of the mean square of adjacent beat-to-beat intervals (RMSSD) (ms) (p<0. 0001), standard deviation 1 (SD1) (ms) (p=0.03) and standard deviation 1/standard deviation 2 (SD1/SD2) ratio (p=0.0003). There was no improvement in sleep quality. Conclusion: Intradialytic resistance exercise is able to improve cardiac autonomic modulation in patients with chronic kidney disease

Objetivo: evaluar los efectos de un programa de ejercicios de resistencia e intradialíticos sobre la calidad del sueño y la modulación autonómica cardíaca en pacientes en hemodiálisis. Método: ensayo clínico no aleatorizado, realizado entre febrero de 2019 y octubre de 2020, junto a 52 individuos en diálisis con insuficiencia renal crónica, divididos en grupo intervención (GI; n=32) y grupo control (GC; n=20). El GI realizó 12 semanas de entrenamiento físico intradialítico, tres veces por semana. Se midieron índices de calidad del sueño y modulación autonómica cardíaca. Resultados: hubo un aumento en los índices de desviación estándar de los intervalos entre latidos (SDNN) (ms) (p=0,0004), raíz cuadrada del cuadrado medio de los intervalos entre latidos adyacentes (RMSSD) (ms) (p<0,0001), desviación estándar 1 (DE1) (ms) (p=0,03) y relación desviación estándar 1/desviación estándar 2 (DE1/DE2) (p=0,0003). No hubo mejoría en la calidad del sueño. Conclusión: el ejercicio de resistencia intradialítico puede mejorar la modulación autonómica cardíaca en pacientes con enfermedad renal crónica.

Modulação Autonômica Cardíaca é Fator Chave para Pressão Alta em Adolescentes / Cardiac Autonomic Modulation is a Key Factor for High Blood Pressure in Adolescentes

Resumo Fundamento O interesse pela hipertensão em crianças e adolescentes aumentou desde a atualização do sistema de classificação da pressão arterial para comparar com o sistema de classificação dos adultos, alterando a terminologia de "normal alta" para "pré-hipertensão". Objetivo O objetivo deste estudo foi analisar a associação da modulação autonômica cardíaca com os níveis pressóricos dos adolescentes. Métodos 203 adolescentes foram agrupados de acordo com a pressão arterial sistólica (PAS) e a pressão arterial diastólica (PAD). Um grupo foi caracterizado como pré-hipertensão, e o outro como normotenso. Foram coletadas características antropométricas, cardiovasculares e de qualidade do sono. Inicialmente, os dados foram submetidos ao teste de normalidade Kolmogorov-Smirnov . As variáveis quantitativas contínuas foram analisadas por meio do teste T de Student não pareado. Para análise das variáveis categóricas, foi utilizado o teste qui-quadrado. Um modelo de regressão logística foi realizado. O nível de significância estabelecido foi p<0,05. Os dados foram expressos como média ± desvio padrão e intervalo de confiança. O software R foi utilizado para análise dos dados. O tamanho do efeito foi calculado com a fórmula de Cohen. Resultados O grupo pré-hipertensão apresentou aumento da entropia de Shannon e diminuição da variância total. Além disso, no modelo de regressão logística, os adolescentes deste grupo tiveram 1,03 mais chances de ter a entropia de Shannon afetada quando a PAS foi ajustada ao gênero, maturação sexual, tempo escolar, idade, circunferência da cintura e qualidade do sono. Conclusão Nossos dados mostram que a modulação autonômica pode desempenhar um papel importante no desenvolvimento da pressão arterial elevada em adolescentes ao controlar fatores como tempo escolar e qualidade do sono.

Abstract Background The interest regarding hypertension among children and adolescents has increased since the blood pressure rating system was updated to be compared with the adult rating system, changing the terminology from "normal high" to "prehypertension". Objective This study aimed to analyze the association between cardiac autonomic modulation and pressure levels of adolescents. Methods 203 adolescents were grouped according to systolic blood pressure (SBP) and diastolic blood pressure (DBP). One group was characterized as prehypertension, and the other as normotensive. Anthropometric, cardiovascular and sleep quality characteristics were collected. Initially, the data were submitted to the Kolmogorov-Smirnov normality test. Continuous quantitative variables were analyzed using the unpaired Student t-test. For the analysis of categorical variables, a chi-square test was used. A logistic regression model was performed. The level of significance was set at p<0.05. The data were expressed as mean ± standard deviation and confidence interval. The R software was used for data analysis. The effect size was calculated using the Cohen's formula. Results The prehypertension group showed an increase in Shannon entropy and a decrease in total variance. Also, in the logistic regression model, adolescents in this group were 1.03 times more likely to have Shannon entropy's affected when SBP was adjusted for gender, sexual maturation, school time, age, waist circumference, and sleep quality. Conclusion Our data show that autonomic modulation may play an important role in the development of elevated blood pressure in adolescents, when controlling for other factors, such as school time and sleep quality.

Cardiac autonomic modulation response and functional capacity in older women / Respuesta de la modulación autonómica cardíaca y capacidad funcional en mujeres mayores / Resposta da modulação autonômica cardíaca e capacidade funcional em mulheres idosas

ABSTRACT Objective: To analyze cardiac autonomic modulation response and functional capacity in physically active older women. Methods: Seventy-five older women (60-70 years) from the community were divided into the following groups: sedentary (n=19), hydro-gymnastics (n=18), pilates (n=19), and dance (n=19). Blood pressure, body composition, heart rate variability, and functional capacity were assessed for the characterization of the groups at rest and 48 hours after the last physical exercise session. Results: The sedentary group presented higher waist-to-hip ratio, diastolic blood pressure, and resting heart rate compared to the other groups (p<0.05). It was also observed that the dance group presented better functional capacity and VO2peak scores (all p<0.05). Regarding cardiac autonomic modulation, both dance and pilates groups demonstrated better RMSSD (26.71 ± 9.07 and 29.82 ± 7.16, respectively; p<0.05), LF (45.79 ± 14.81 and 45.95 ± 15.16 n.u., respectively; p<0.05), and LF/HF (0.92 ± 0.56 and 0.58 ± 0.26, respectively; p<0.05) scores. In the symbolic analysis, the dance group had a greater predominance of parasympathetic autonomic modulation than the other groups (p<0.05). Conclusion: These results conclude that physically active elderly women, practicing hydro-gymnastics, pilates or dance, presented physiological benefits, such as better functional capacity and improvements in hemodynamic variables and autonomic cardiac modulation. In addition, the group that practiced dance presented greater parasympathetic modulation, as well as greater functional capacity, when compared to the other modalities. Level of evidence: I; STARD: studies of diagnostic accuracy.

RESUMEN Objetivo: Analizar la respuesta de la modulación autonómica cardíaca y la capacidad funcional en mujeres mayores físicamente activas. Métodos: Setenta y cinco mujeres mayores (60 a 70 años) de la comunidad fueron divididas en los siguientes grupos: sedentaria (n = 19), hidrogimnasia (n = 18), pilates (n = 19) y danza (n = 19). La presión arterial, la composición corporal, la variabilidad de la frecuencia cardíaca y la capacidad funcional fueron evaluadas para la caracterización de los grupos en reposo y 48 horas después de la última sesión de ejercicio físico. Resultados: El grupo sedentario presentó mayor relación cintura-cadera, presión arterial diastólica y frecuencia cardíaca en reposo cuando comparado a los otros grupos (p <0,05). Se observó que el grupo de danza presentó mejores puntajes de capacidad funcional y VO2Pico (todos p <0,05). Con relación a la modulación autonómica cardíaca, los grupos de danza y pilates demostraron mejores puntajes para RMSSD (26,71 ± 9,07 y 29,82 ± 7,16, respectivamente; p <0,05), LF (45,79 ± 14,81 y 45,95 ± 15,16 nu, respectivamente; p <0,05), y LF/HF (0,92 ± 0,56 y 0,58 ± 0,26, respectivamente; p <0,05). En el análisis simbólico, el grupo de danza presentó mayor predominancia de la modulación autonómica parasimpática que los demás grupos (p <0,05). Conclusión: Esos resultados concluyen que las mujeres mayores físicamente activas, practicantes de hidrogimnasia, pilates o danza, tienen beneficios fisiológicos, como mejor capacidad funcional y mejora de las variables hemodinámicas y de la modulación cardíaca autonómica. Además, el grupo que practicaba danza tuvo mayor modulación parasimpática y mayor capacidad funcional cuando comparado con las otras modalidades. Nivel de evidencia: I; STARD: estudios de precisión diagnóstica.

RESUMO Objetivo: Analisar a resposta da modulação autonômica cardíaca e a capacidade funcional em idosas fisicamente ativas. Métodos: Setenta e cinco mulheres idosas (60 a 70 anos) da comunidade foram divididas nos seguintes grupos: sedentária (n = 19), hidroginástica (n = 18), pilates (n = 19) e dança (n = 19). A pressão arterial, a composição corporal, a variabilidade da frequência cardíaca e a capacidade funcional foram avaliadas para a caracterização dos grupos em repouso e 48 horas depois da última sessão de exercício físico. Resultados: O grupo sedentário apresentou maior relação cintura-quadril, pressão arterial diastólica e frequência cardíaca em repouso quando comparado aos outros grupos (p <0,05). Observou-se também que o grupo da dança apresentou melhores escores de capacidade funcional e VO2pico (todos p < 0,05). Com relação à modulação autonômica cardíaca, os grupos de dança e pilates demonstraram melhores escores para RMSSD (26,71 ± 9,07 e 29,82 ± 7,16, respectivamente; p < 0,05), LF (45,79 ± 14,81 e 45,95 ± 15,16 nu, respectivamente; p<0,05) e LF/HF (0,92 ± 0,56 e 0,58 ± 0,26, respectivamente; p < 0,05). Na análise simbólica, o grupo da dança apresentou maior predominância da modulação autonômica parassimpática do que os demais grupos (p < 0,05). Conclusão: Esses resultados concluem que idosas fisicamente ativas praticantes de hidroginástica, pilates ou dança, têm benefícios fisiológicos, como melhor capacidade funcional e melhora das variáveis hemodinâmicas e da modulação cardíaca autonômica. Além disso, o grupo que praticava dança teve maior modulação parassimpática e maior capacidade funcional quando comparado com outras modalidades. Nível de evidência: I; STARD: estudos de precisão diagnóstica.

Obesity as an additional factor for autonomic imbalance and poor sleep behavior in chronic obstructive pulmonary disease: a case-control study

OBJECTIVES: We compared the autonomic modulation and sleep behavior of eutrophic and overweight patients with chronic obstructive pulmonary disease (COPD). METHODS: COPD participants were divided into the overweight and eutrophic groups. Pulmonary function, blood pressure, body composition, autonomic modulation, and the Pittsburgh Sleep Quality Index score were assessed. Participants performed the six-minute walk test for functional assessment. RESULTS: Spirometric variables obtained in eutrophic and overweight individuals with COPD showed no statistically different results. We observed that the SDNN index indicated lower overall variability (p=0.003), and root mean square of successive differences between normal heart beats (RMSSD) (p=0.04) indicated lower parasympathetic modulation in the overweight group than observed in the eutrophic group. The indexes of the frequency domain presented lower values of total variability (p<0.01), low frequency bands (p<0.01), and high frequency (p=0.02), suggesting a higher sympathetic modulation and reduced parasympathetic modulation of the overweight group compared to eutrophic group. The overweight group also showed reduced sleep quality than the eutrophic group. CONCLUSION: Overweight COPD patients showed lower autonomic modulation and impaired sleep quality, latency, and efficiency as compared eutrophic subjects. These results reinforce the importance of weight control and the acquisition of healthy habits in this population.

Influence of Family History of Diabetes on Cardiac Autonomic Dysfunction of Adolescents

Abstract Background To evaluate cardiac autonomic modulation of adolescents with a family history of diabetic parents. Objective This study aims to evaluate the influence of a family history of diabetes on cardiac autonomic modulation. Methods This is an analytical and cross-sectional study on adolescents between 11 and 18 years of age, of both genders, who were divided into group with a family history of diabetes and a control group without a family history of diabetes. The study protocol consisted of the analysis of heart rate variability, blood pressure, anthropometric measurements, and body composition. Also, by using questionnaires, level of physical activity, sexual maturation, and sleep quality were evaluated. Normality of data distribution was tested using the Kolmogorov-Smirnov test. Then, statistical significance was evaluated using the Student's t-test, and the Cohen's teste was used for calculation of the effect size. The level of significance adopted in the statistical analysis was 5%. Results When the group of individuals with a family history of diabetes was compared with the control group, statistically significant differences were observed in the variables the standard deviation of the NN time series interval (SDNN) (43.9 ± 2.2 vs. 53.5 ± 2.6 ms), the square root of the quadratic differences (RMSSD) (41.9 ± 3.3 vs. 52.4 ± 3.2 ms), standard deviation of beat-to-beat instantaneous variability (SD1) (29.7 ± 2.3 vs. 37.1 ± 2.3 ms), long-term standard deviation of continuous RR intervals (SD2) (. 54.1 ± 2.6 vs. 66.66 ± 3.5 ms), and in low frequency (LF) (496.0 ± 49.5 vs. 728 ± 71.6 ms2) and high frequency (HF) (1050.0 ± 120.4 vs. 737.4 ± 98.5 ms2) in the frequency domain. Conclusions Global autonomic modulation is decreased in adolescents with a family history of diabetes. We also observed a decrease in vagal activity in this group. So, sympathetic autonomic modulation is predominant in this population. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0)

Estimated intensity and acute cardiovascular response to a single exercise session guided by the fitness app Sworkit® Personal Trainer

Aim: The aim of the present study was to evaluate the effect of an exercise session prescribed by the Sworkit® Personal Trainer application on hemodynamic and autonomic responses. Methods: The sample consisted of 11 men classified as sedentary according to IPAQ. The exercises were randomly selected by the app Sworkit® Personal Trainer, using the pre-built program "Light Warm-Up Cardio" (see supplementary material). Heart rate and perceived exertion data were collected every minute during an exercise session. Blood pressure and heart rate variability were measured Pre, Post, 30 min, 12h, 24 h, and 48h after exercise. Heart rate and rate of perceived exertion were collected during the 30 minutes exercise. Results: Hemodynamic responses showed differences in heart rate and systolic blood pressure: Post, 12 h and 24 h compared to Pre. We also found significant statistical differences in the heart rate variability indexes when comparing Post, 30min to 48h versus Pre, indicating modifications in the autonomic modulation post-exercise. The perceived exertions scale remained between 13-14 during the exercise. Heart rate was 149 ± 5.26 (80 ± 5% of HRmax) during the 30min exercise, indicating a moderate to vigorous intensity. Conclusion: We concluded that a single exercise session guided by the Sworkit® Personal Trainer application could generate autonomic changes in up to 12 hours, presenting a moderate to vigorous intensity in 30 minutes of exercise for sedentary men.(AU)

Impacts of low or vigorous levels of physical activity on body composition, hemodynamics and autonomic modulation in Down syndrome subjects

Aim: We aimed to evaluate the effect of low and vigorous levels of physical activity in body composition, hemodynamics and autonomic modulation in subjects with Down syndrome (DS). METHODS: We evaluated 13 healthy subjects without DS (control group), 15 sedentary subjects with DS, (SED DS group), nine with DS with low intensity levels of physical activity (LIDS) and 12 with DS with vigorous levels of physical activity (VIDS). The physical activity level was measured using the IPAQ questionnaire. Body composition, hemodynamics and autonomic modulation were also evaluated. RESULTS The VIDS showed lower BMI than the control and SED DS group. Body fat (%) was lower in LIDS and VIDS than in the control and SED DS group. The systolic and diastolic arterial pressure values were similar among the groups. When normalized, the frequency domain showed higher LF/HF, higher LF (nu) and lower HF (nu) component of heart rate variability in sedentary DS than in the control group. However, LIDS and VIDS groups showed similar values in LF (nu), HF (nu) and LF/HF than the control group. The symbolic analysis showed greater 0V and lower values in 2LV in sedentary DS group when compared to the control group. However, the LIDS and VIDS did not show difference in 0V when compared to the control group. The 2LV was lower in LIDS and VIDS than in the control group, but 2UV was higher in VIDS than in the control group. CONCLUSION: We conclude that, regardless of the intensity, exercise can promote positive adaptations in the autonomic modulation of DS patients.(AU)

Corrida em ambiente quente altera o perfil leucocitário de sujeitos treinados saudáveis / Race in a hot environment changes the leukocyte profile in healthy trained subjects

OBJETIVOS: Analisar os efeitos de uma corrida de 15 km ao ar livre em ambiente de alta temperatura na modulação da leucocitose em homens saudáveis treinados em corrida. MÉTODOS: A amostra foi composta por 14 homens que participavam de um grupo de corrida recreativo. Foram incluídos voluntários que declarassem ser capazes de percorrer a distância mínima de 15 km, não estivessem tomando nenhum medicamento imunossupressor e não tivessem nenhuma doença infecciosa. Os critérios de exclusão foram hipertensão arterial em repouso antes da corrida, histórico de doenças osteomioarticulares, metabólicas e/ou cardiovasculares, e não completar o percurso da corrida. Amostras de sangue venoso antes e após a corrida foram coletadas para determinação do hematócrito e contagem de células imunes por imunocitoquímica. RESULTADOS: Observou-se aumento no número de leucócitos totais e neutrófilos no momento pós corrida (9,31±2,4×10³ células/µL e 7,64±3,4×10³ células/µL respectivamente) em comparação ao momento pré corrida (5,52±0.2×10³ células/µL e 2,90±0,6×10³ células/µL respectivamente) (p<0,05). Houve diminuição no número de linfócitos e eosinófilos no momento pós corrida (1,34±0,3×10³ e 0,36±0,2×10³ células/µL respectivamente) comparado ao pré corrida (1,67±0,3×10³ e 0,22±0,1×10³ células/µL respectivamente) (p<0,05). Não foram observadas diferenças significativas no número de monócitos e basófilos no momento pós corrida (0,45±0,1×10³ e 0,9±0,3×10³ células/µL respectivamente) comparado ao pré corrida (0,40±0,08×10³ e 0,8±0,3×10³ células/µL respectivamente) (p>0,05). CONCLUSÕES: A corrida de 15 km ao ar livre, em ambiente de alta temperatura, induziu a uma cinética leucocitária típica, com leucocitose às custas do aumento no número de neutrófilos, assim como queda no número de linfócitos e eosinófilos, em homens saudáveis com prévio treinamento em corrida. Estes resultados ajudam a compreender melhor a leucocitose induzida pelo exercício e podem indicar a intensidade do estresse promovido pelo exercício em condições ambientais extremas.

AIMS: To assess the effects of an outdoor race of 15 km in a hot environment on leukocyte kinetics in healthy trained men. METHODS: The sample consisted of 14 men who participated in a recreational race group. Volunteers who said they were able to run a minimum distance of 15 km, were not taking any immunosuppressants, and had no infectious disease were included in the study. The exclusion criteria were the following: hypertension at rest before the race, history of musculoskeletal, metabolic and/or cardiovascular diseases, and failure to finish the race. Venous blood samples were collected before and after the race for determination of hematocrit levels and immune cell count by immunocytochemistry. RESULTS: An increase in total leukocyte and neutrophil count was observed after the race (9.31±2.4×10³ cells/µL and 7.64±3.4×10³ cells/µL, respectively) compared to the pre-race period (5.52±0.2×10³ cells/µL and 2.90±0.6×103 cells/µL, respectively), (p<0.05). There was a decrease in lymphocyte and eosinophil count after the race (1.34±0.3×10³ and 0.36±0.2×10³ cells/µL, respectively) compared to the pre-race period (1.67±0.3×10³ and 0.22±0.1×10³ cells/µL, respectively) (p<0.05). There was no statistically significant difference in monocyte and basophil count after the race (0.45±0.1×10³ and 0.9±0.3×10³ cells/µL, respectively) compared to the pre-race period (0.40±0.08×10³ and 0.8±0.3×10³cells/µL, respectively) (p>0.05). CONCLUSIONS: The 15-km outdoor race in a hot environment led to a typical leukocyte kinetics, resulting in leukocytosis owing to the increase in neutrophil count as well as to a decrease in lymphocyte and eosinophil count in healthy trained men. These findings shed some further light upon exercise-induced leukocytosis and may indicate the level of stress produced by exercise under extreme environmental conditions.