Combined effect of physical exercise and hormone replacement therapy on cardiovascular and metabolic health in postmenopausal women: A systematic review and meta-analysis

The cardioprotective effect of postmenopausal hormone replacement therapy (HRT) has been demonstrated in several studies. Similarly, physical exercise has yielded positive results. However, the effects of their combination remain inconclusive. This review describes the combined effects of physical exercise and hormone therapy on cardiovascular and metabolic health in postmenopausal women. We searched the Scopus, Web of Science, PubMed, and Embase databases and included randomized controlled trials published up to December 2021 on the combined effects of physical exercise and hormone therapy on cardiovascular and metabolic health in postmenopausal women. We identified 148 articles, of which only seven met the inclusion criteria (386 participants; 91 [23%] HRT + exercise; 104 [27%] HRT; 103 [27%] exercise; 88 [23%] placebo). The combined treatment further decreased systolic blood pressure (SBP) compared to the isolated effect of aerobic training (AT) (mean difference [MD]=-1.69; 95% confidence interval [CI]=-2.65 to -0.72, n=73). Nevertheless, it attenuated the decrease in diastolic blood pressure (DBP) (MD=0.78; 95%CI: 0.22-1.35, n=73), and the increase in peak oxygen consumption (VO2 peak) promoted by exercise (AT + HRT=2.8±1.4 vs AT + placebo=5.8±3.4, P=0.02). The combination of AT and oral HRT improved SBP. However, AT alone seemed to have a better effect on physical fitness and DBP in postmenopausal women.

Role of aerobic physical training on cardiac autonomic and morphophysiological dysfunction in hypertensive rats subjected to ovarian hormone deprivation

Here we investigated the effects of physical training on cardiovascular autonomic control and cardiac morphofunctional parameters in spontaneously hypertensive rats (SHRs) subjected to ovarian hormone deprivation. Forty-eight 10-week-old SHRs were divided into two groups: ovariectomized (OVX, n=24) and sham (SHAM, n=24). Half of each group (n=12) was trained by swimming for 12 weeks (OVX-T and SHAM-T). Cardiac morphology and functionality were assessed using echocardiography, and autonomic parameters were assessed using double pharmacological autonomic block, baroreflex sensitivity (BRS), and analyses of heart rate variability (HRV) and blood pressure variability (BPV). Ovariectomy did not influence the cardiac autonomic tonus balance unlike physical training, which favored greater participation of the vagal autonomic tonus. Ovariectomy and aerobic physical training did not modify HRV and BRS, unlike BPV, for which both methods reduced low-frequency oscillations, suggesting a reduction in sympathetic vascular modulation. Untrained ovariectomized animals showed a reduced relative wall thickness (RWT) and increased diastolic and systolic volumes and left ventricular diameters, resulting in increased stroke volume. Trained ovariectomized animals presented reduced posterior wall thickness and RWT as well as increased final diastolic diameter, left ventricular mass, and stroke volume. Ovarian hormone deprivation in SHRs promoted morphofunctional adaptations but did not alter the evaluation of cardiac autonomic parameters. In turn, aerobic physical training contributed to a more favorable cardiac autonomic balance to the vagal autonomic component and promoted morphological adaptations but had little effect on cardiac functionality.

Effects of respiratory muscle training on parasympathetic activity in diabetes mellitus

This study verified the effects of respiratory muscle training (RMT) on hemodynamics, heart rate (HR) variability, and muscle morphology in rats with streptozotocin-induced diabetes mellitus (DM). Thirty-six male Wistar rats were randomized into 4 groups and 34 completed the study: i) sham-sedentary (Sham-ST; n=9); ii) sham-RMT (Sham-RMT; n=9); iii) DM-sedentary (DM-ST; n=8); and iv) DM-RMT (DM-RMT; n=8). Hemodynamics were assessed by central cannulation, and R-R intervals were measured by electrocardiogram. In addition, the effects of RMT on the cross-sectional area of the diaphragm, anterior tibial, and soleus muscles were analyzed. The induction of DM by streptozotocin resulted in weight loss, hyperglycemia, reduced blood pressure, and attenuated left ventricular contraction and relaxation (P<0.05). We also observed a decrease in root mean square of successive differences between adjacent RR intervals (RMSSD) index and in the cross-sectional area of the muscles assessed, specifically the diaphragm, soleus, and anterior tibial muscles in diabetic rats (P<0.05). Interestingly, RMT led to an increase in RMSSD in rats with DM (P<0.05). The induction of DM produced profound deleterious changes in the diaphragmatic and peripheral muscles, as well as impairments in cardiovascular hemodynamics and autonomic control. Nevertheless, RMT may beneficially attenuate autonomic changes and improve parasympathetic modulation.

Benefícios da cinesioterapia respiratória no pós-operatório de colecistectomia laparoscópica / Benefits of postoperative respiratory kinesiotherapy following laparoscopic cholecystectomy

INTRODUÇÃO: Alterações da função pulmonar após cirurgia abdominal levam à redução do volume pulmonar, prejudicando as trocas gasosas. OBJETIVO: Avaliar os efeitos da cinesioterapia respiratória sobre a função pulmonar e a força muscular respiratória em pacientes submetidos à colecistectomia laparoscópica. MATERIAIS E MÉTODOS: Em estudo prospectivo, 20 mulheres e 16 homens (idade: 48,4 ± 9,55 anos), submetidos à colecistectomia laparoscópica, foram divididos aleatoriamente: 17 realizaram exercícios respiratórios (respiração diafragmática, sustentação máxima da inspiração e inspiração fracionada) e 19 participaram como Grupo Controle. Todos realizaram avaliação das pressões respiratórias máximas (PImax e PEmax), pico de fluxo expiratório (PFE) e espirometria, medindo capacidade vital (CV), capacidade vital forçada (CVF), volume expiratório no primeiro segundo (VEF1), relação VEF1/CVF no pré-operatório e diariamente até o sexto pós-operatório (PO). RESULTADOS: Os valores de pré-operatório não foram estatisticamente diferentes entre os dois grupos. Ambos os grupos apresentaram diminuição de todas as variáveis no 1º PO (p< 0,05). O Grupo Exercício permaneceu com diminuição até o 2º PO para CV, CVF e VEF1 (p< 0,05), 3º PO para PImax e PFE (p< 0,05) e 4º PO para PEmax (p< 0,05), enquanto que, no Grupo Controle, os valores de todas as variáveis retornaram a partir do 5º PO. Os valores de PImax e PEmax foram maiores no Grupo Exercício que no Grupo Controle desde o 3º e 2º PO (p< 0,05), respectivamente. CONCLUSÕES: A cinesioterapia respiratória contribuiu para a recuperação precoce da função pulmonar e da força muscular dos pacientes submetidos à colecistectomia laparoscópica.

INTRODUCTION: Pulmonary function changes following abdominal surgery lead to reduced pulmonary volume, thus compromising gas exchanges. OBJECTIVE: To evaluate the effects of respiratory kinesiotherapy on pulmonary function and respiratory muscle strength in patients who underwent laparoscopic cholecystectomy. METHODS: Twenty women and 16 men (age 48.4 ± 9.55 years) who underwent laparoscopic cholecystectomy were prospectively studied. They were randomly divided as follows: 17 subjects performed breathing exercises (diaphragmatic respiration, maximum sustained inspiration and fractional inspiration) and 19 participated as a Control Group. All of them underwent evaluations of maximal inspiratory and expiratory pressures (MIP and MEP), peak expiratory flow (PEF) and spirometry, with measurements of vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in the first second (FEV1) and the FEV1/FVC ratio before the operation and daily until the sixth postoperative day (POD). RESULTS: The preoperative parameters were not statistically different between the two groups. Both groups presented decreases in all variables on the first POD (p< 0.05). The Exercise Group continued to present decreased values until the second POD for VC, FVC, and FEV1 (p< 0.05), until the third POD for MIP and PEF (p< 0.05) and the fourth POD for MEP (p< 0.05). For the Control Group, the values of all the variables began to normalize on the fifth POD. The MIP and MEP values in the Exercise Group were higher than those in the controls, from the third and second POD onwards, respectively. CONCLUSIONS: Respiratory kinesiotherapy contributed towards early recovery of pulmonary function and muscle strength among patients who had undergone laparoscopic cholecystectomy.