Métodos de estimativa do gasto energético em amputados de membro inferior: uma revisão sistemática / Methods of estimating energy expenditure in lower limb amputees: a systematic review

Objetivo: Identificar os métodos utilizados para determinar o gasto energético de pessoas com amputação de membro inferior. Método: Revisão sistemática, foram selecionadas as bases de dados MedLine (Medical Literature Analysis and Retrieval System on-line) via Pubmed, Web of Science, Scopus (Elsevier), PsycINFO - APA Psycnet (American Psychological Association) e SPORTDiscus. Foram incluídos estudos originais, observacionais, experimentais, que abordaram a temática do gasto energético em amputados de membro inferior, disponíveis na íntegra, nos idiomas inglês, português e espanhol. Resultados: Os estudos utilizaram principalmente a avaliação do consumo de oxigênio (VO2) por meio do teste de Ergoespirometria e o Índice de Custo Fisiológico através da Frequência Cardíaca. No entanto, algumas pesquisas utilizaram a Escala Subjetiva de Percepção de Esforço, a Escala de aptidão autorreferida e um questionário relacionado a percepção da capacidade de andar. Conclusão: O VO2 é a variável mais fidedigna para avaliação do consumo energético, contudo, testes com medidas diretas podem ser mais difíceis de aplicar, pelas alterações recorrentes à amputação, podendo comprometer o resultado, assim, o uso de variáveis que estimem o consumo energético por meio de medidas indiretas se torna uma alternativa válida, mas é necessário atentar- se no uso da Frequência Cardíaca em populações que utilizem algum tipo de medicamento que possa alterar ou comprometer o resultado.

Objective: The objective of the present study was to identify the methods used to determine energy consumption of people with lower limb amputation. Methods: Systematic review, MedLine (Medical Literature Analysis and Retrieval System online) databases were selected via Pubmed, Web of Science, Scopus (Elsevier), PsycINFO - APA Psycnet (American Psychological Association) and SPORTDiscus . Eligibility criteria: Original, observational, experimental studies, which addressed the topic of energy consumption in lower limb amputees, available in full, in English, Portuguese and Spanish. Results: The studies used mainly the assessment of oxygen consumption (VO2) using the Ergospirometry test and the Physiological Cost Index through Heart Rate. However, some researches used the Subjective Scale of Perception of Effort, the Scale of self-reported fitness and a questionnaire related to the perception of the ability to walk. Conclusion: VO2 is the most reliable variable for assessing energy consumption, however, tests with direct measures can be more difficult to apply, due to recurrent changes to amputation, which may compromise the result, thus the use of variables that estimate energy consumption. through indirect measures it becomes a valid alternative, but it is necessary to pay attention to the use of heart rate in populations that use some type of medication that may alter or compromise the result.

Do estimated metabolic equivalent and energy expenditure verify the physical effort of type-1 diabetics in resting and exercise situations? A randomized crossover trial / O equivalente metabólico estimado e o gasto energético verificam o esforço físico de diabéticos tipo 1 em repouso e exercícios? Um ensaio cruzado randomizado / ¿El equivalente metabólico y el gasto energético estimados verifican el esfuerzo físico de los diabéticos tipo 1 en situaciones de reposo y ejercicio? Un ensayo cruzado aleatorio

ABSTRACT To compare measured and estimated metabolic equivalent (MET) and energy expenditure (EE) in different situations with Type-1 diabetes (T1DM) patients. Ten T1DM patients performed three 30-minute sessions (resting, running-RS, and exergame-VS) at moderate intensity. MET and EE were measured by direct gas analyzer and estimated using the formula applying heart rate and V̇02peak. MET values (measured vs. estimated) were statistically different during RS (4.58±1.11 vs.7.59±1.36) and VS (3.98± 0.84 vs. 5.77±0.84) (p<0.001). EE values were similar: RS (147±43 vs. 246±157) and VS (129±33 vs. 184±20) (p<0.001). The error between the methods: 0.41, 1.51, and 1.07 METs and 20.1, 51.5, and 32.5 Kcals for resting, RS, and VS. Estimation could be used in resting and with caution for RS and VS.

RESUMO Comparar o equivalente metabólico (MET) medido e estimado e o gasto energético (EE) em diferentes situações em pacientes com diabetes tipo 1 (DM1). Dez DM1 realizaram três sessões de 30 minutos (Repouso, Corrida-RS e Exergame-VS) em intensidade moderada. MET e EE foram medidos por um analisador direto de gases e estimados pela fórmula usando frequência cardíaca e V̇02pico. Valores MET (medidos vs. estimados) foram estatisticamente diferentes durante o RS (4,58±1,11 vs. 7,59±1,36) e o VS (3,98±0,84 vs. 5,77±0,84) (p<0,001). Semelhante em EE: RS (147±43 vs. 246±157) e VS (129±33 vs. 184±20) (p<0,001). O erro entre os métodos: 0,41, 1,51 e 1,07 MET e 20,1, 51,5 e 32,5 Kcal para Repouso, RS e VS. A estimativa pode ser usada em repouso e com cuidado durante RS e VS.

RESUMEN Comparar el equivalente metabólico (MET)y gasto energético (EE) medido y estimado en diferentes situaciones en diabeticos tipo-1 (T1DM). Diez T1DM realizaron tres sesiones de 30 minutos (Descanso, Running-RS y Exergame-VS) en intensidad moderada. El MET y EE se midieron con un analizador de gases y se calcularon con fórmula utilizando la frecuencia cardíaca y VO2pico. Valores MET (medidos frente a estimados) eran estadísticamente diferentes durante RS (4,58±1,11 vs 7,59±1,36) y VS (3,98±0,84 vs 5,77±0,84) (p<0,001). Similar en EE: RS (147±43 vs 246±157) y VS (129±33 vs 184±20) (p<0,001). El error entre los métodos: 0.41, 1.51 y 1.07 MET y 20.1, 51.5 y 32.5 Kcal para Reposo, RS y VS. La estimación podría usarse en reposo y con cuidado durante RS y VS.

Evaluación y utilidad del cuestionario DASI (duke activity score index) para la estimación de capacidad funcional en población chilena / A spanish version of the DASI questionnaire for estimation of functional capacity and cardiovascular risk applied to a chilean population

RESUMEN: El Duke Activity Status Index (DASI) es un cuestionario inglés utilizado para la estimación de capacidad funcional, que se ha correlacionado con equivalentes metabólicos (METs) y con consumo de oxígeno (VO2max). No existe información de su aplicación en población chilena. El objetivo fue evaluar la utilidad de una versión de DASI traducida al español y adaptada a población local, para predecir capacidad funcional determinada en prueba de esfuerzo máxima. Método: Se tradujo al español el DASI junto con adaptación de preguntas para población local. El cuestionario fue auto administrado previo a la realización de una prueba de esfuerzo máximo, sólo detenida por síntomas y percepción de esfuerzo de ≥17 /20 en escala de Borg. Se correlacionó METs con VO2max logrados en esfuerzo versus los estimados por DASI. Resultados: Se incorporaron 480 sujetos (edad x:50.9 ±15.3 años). La mediana (IQ) de METS estimados por DASI fue 9,2 (8,2-9,8). El valor α de Cronbach y Formula 20 de Kuder Richardson fue 0,72. El cuestionario fue de rápida aplicación. Se observó correlación significativa entre METs (r: 0.44; p< 0.001) y VO2max (r: 0,37; p< 0.001) determinados por cuestionario DASI y prueba de esfuerzo máxima. Conclusión: El DASI traducido y adaptado a población chilena es un instrumento sencillo de completar, que se correlaciona positivamente con capacidad funcional de forma similar a lo descrito en otros países, entregando una herramienta útil para la evaluación y predicción de riesgo cardiovascular.

ABSTRACT: The Duke Activity Status Index (DASI) is an English questionnaire used to estimate functional capacity and physical fitness that correlates with peak oxygen uptake (VO2max) and metabolic equivalents (METs). There is no available information of its application in Chilean population. Aim: to assess the efficacy of a Spanish version of the DASI questionnaire in predicting functional capacity in a Chilean population. Methods: DASI was translated into a Spanish version and adapted to local population and culture. The questionnaire was self-administered prior to carrying out a treadmill exercise stress testing, stopped only by symptoms or a perception of stress ≥17 / 20 on the Borg scale. Internal consistency was estimated with two tests. A correlation was performed between the METs and VO2max achieved in treadmill stress testing versus those estimated by DASI. Results: 480 subjects were enrolled (age x: 50.9 ±15.3 years old). The median (IQ) DASI score was 9,2 (8,2-9,8). Both Cronbach´s α and Kuder Richardson Formula 20 were 0,72. DASI was easy and quick to apply. A significant correlation was observed between METS by DASI and those estimated by stress testing (r: 0.44: p<0.001); the same was true for the estimation of VO2max (r:0.37: p<0.001). Conclusion: The Spanish DASI translation adapted to Chilean population is an easy instrument to apply. Results are similar those obtained in other countries in the estimation of functional capacity.

Padrão de atividade física em gestantes usuárias do Sistema Público de Saúde / Physical activity pattern among pregnant women users of the Brazilian Public Health System / Patrón de actividad física em mujeres embarazadas usuárias del Sistema de Salud Pública

Objetivos: Descrever o padrão de atividade física de gestantes usuárias de Unidades Básicas de Saúde, investigar a média do gasto energético relacionados aos domínios de atividade física. Métodos: Trata-se de um estudo transversal conduzido entre 799 gestantes atendidas nas Unidades Básicas de Saúde de Ribeirão Preto, SP. A prática de atividade física foi avaliada por meio do questionário de "frequência de atividade física diária" específico para gestantes, no qual foram obtidas a frequência, duração e o equivalentes metabólicos das atividades físicas. Resultados: A maioria das gestantes apresentaram o padrão sedentário (57%) seguido pelo padrão leve (43%). Em relação aos domínios de atividades físicas, o domínio doméstico teve a maior média de gasto energético (733,7), enquanto que, o domínio de lazer apresentou a menor média (20,5). Verificou-se que as variáveis idade acima de 30 anos , escolaridade baixa , solteira, não ser chefe de família, não trabalhar fora, e ter filhos, tiveram associações com o padrão sedentário. Conclusões: Elevada prevalência de sedentarismo foi observada entre as gestantes estudadas, sugerindo a necessidade de ações de promoção de atividade física neste público, principalmente no domínio de lazer.

Objective: To describe the physical activity pattern of pregnant women using Basic Health Units to investigate the average energy expenditure related to physical activity domains. Methods: This is a cross-sectional study conducted with 799 pregnant women attended at Basic Health Units in Ribeirão Preto, SP. The practice of physical activity was assessed using the "frequency of daily physical activity" questionnaire specific for pregnant women, in which the frequency, duration and metabolic equivalents of physical activities were obtained. Results: Most pregnant women had a sedentary pattern (57%) followed by a mild pattern (43%). Regarding the domains of physical activities, the domestic domain had the highest average of energy expenditure (733.7), while the leisure domain presented the lowest average (20.5). It was found that the variables: older than 30 years old, low schooling, single, not head of family, not working outside the home, and having children had associations with the sedentary pattern. Conclusions: A high prevalence of physical inactivity was observed among the studied pregnant women, suggesting the need for actions to promote physical activity in this public, mainly in the leisure domain.

Objetivos: Describir el patrón de actividad física de las mujeres embarazadas que utilizan Unidades Básicas de Salud, para investigar el gasto energético promedio relacionado con los dominios de la actividad física. Métodos: Este es un estudio transversal realizado entre 799 mujeres embarazadas atendidas en las Unidades Básicas de Salud en Ribeirão Preto, SP. La práctica de actividad física se evaluó mediante el cuestionario de "frecuencia de actividad física diaria" específico para mujeres embarazadas, en el que se obtuvo la frecuencia, duración y equivalentes metabólicos de las actividades físicas. Resultados: la mayoría de las mujeres embarazadas tenían un patrón sedentario (57%) seguido de un patrón leve (43%). En cuanto a los dominios de las actividades físicas, el dominio doméstico tuvo el promedio más alto de gasto energético (733.7), mientras que el dominio del ocio presentó el promedio más bajo (20.5). Se encontró que las variables mayores de 30 años, baja escolaridad, soltero, no ser cabeza de familia, no trabajar fuera del hogar y tener hijos, tenían asociaciones con el patrón sedentario. Conclusiones: se observó una alta prevalencia de inactividad física entre las mujeres embarazadas estudiadas, lo que sugiere la necesidad de acciones para promover la actividad física en este público, principalmente en el dominio del ocio.

Comparative study of anterior support ankle foot orthosis and posterior ankle foot orthosis in foot drop patients

Background: Anterior Support Ankle Foot Orthosis (A-AFO) is a fairly recent approach. There is dearth of studies relating to comparison of metabolic efficiency of A-AFO and P-AFO. Objective was to study the efficacy of A-AFO compared to P-AFO in foot drop patients, using gait and metabolic analysis.Methods: It was a cross over study, included foot drop patients who could walk with/ without orthosis. Patients having spasticity more than grade 2 (Modified Ashworth Scale) were excluded. The metabolic parameters measured were volume of Oxygen consumed at Standard Temperature and Pressure in l/min (VO2), Dry in l/min, Rate of Oxygen consumption (MET), Volume of Carbon dioxide produced in litre/min (VCO2). Along with various gait parameters, questionnaire about patient’s preference after 4 weeks was also incorporated.Results: A-AFO was significantly better than P-AFO in terms of VO2 and VCO2 (p value = 0.02 and 0.009 respectively) as well as in terms of subjective preference.Conclusions: A-AFO is comparable to P-AFO in terms of energy efficiency, gait parameters and subjective preference, hence should also be prescribed.

Comparative Analysis On The Efficacy Of Aerobic Capacity In Cardiac Rehabilitation Obese And Non-Obese Phase Ii Patient

Background: Aerobic Exercise is a host of health benefits to reduce vigor risk and maintain body weight. The purpose of the present investigation is to determine the influence of aerobic exercises on body weight and Metabolic Equivalent of Task (MET) activity among cardiac rehabilitation phase II patients. The objective of the study is to investigate the impact of obesity on the efficacy of aerobic capacity. Methods: Fifteen obese (ten males, five females) and fifteen non-obese (eleven males, four females) participants of phase II cardiac rehabilitation were selected from a tertiary care hospital by their Body Mass Index (BMI). They were divided into two groups by simple random technique. Aerobic exercises were given for 12 weeks for post-CABG cardiac rehabilitation phase II obese and non-obese (healthy and overweight) patients. BMI and the Metabolic equivalent of task activity of cardiac rehabilitation phase II patients are measured by enrolling a patient in 12 weeks of aerobic exercises program. Results: The aerobic exercise shows a positive result in both obese and non-obese patients. Aerobic exercises improved metabolic equivalent of task in both obese(4.6667+_0.65134 ;< 0.05) and non-obese patients (4.6923+_.48038 ;< 0.05) significantly.But aerobic exercises were more effective in enhancing the efficacy of aerobic capacity in obese patients. Conclusion: It is evident that aerobic exercises are more effective for obese patients to maintain or reduces weight. Higher MET activity was observed in obese patients.

Energy Expenditures for Activities of Daily Living in Korean Young Adults: A Preliminary Study

OBJECTIVE: To investigate the energy expenditure (EE) of Korean young adults based on activities refined to a deskbound lifestyle. METHODS: Sixty-four healthy office workers aged between 25 and 46 years participated in this study. EE was expressed as metabolic equivalent of task (MET). Participants were evaluated in terms of their EE during physical activities of sleeping (n=22), typing (n=37), folding laundry (n=34), dishwashing (n=32), studying (n=18), mopping (n=35), walking (n=33), stair climbing (n=23), and running (n=29). Volume of oxygen consumption was measured by indirect calorimetry K4b² (COSMED). The results were compared to the established Compendium MET. RESULTS: The MET of activities were: sleeping, 1.24±0.43; typing, 1.35±0.25; folding laundry, 1.58±0.51; dishwashing, 2.20±0.51; studying, 2.11±0.90; mopping, 2.72±0.69; walking at 4 km/hr, 3.48±0.65; stair climbing of five stories, 6.18±1.08; and running at 8 km/hr, 7.57±0.57. The values of typing and mopping were similar to those in the Compendium, whereas those of sleeping, folding laundry, dishwashing, studying, walking, stair climbing and running were different. CONCLUSION: To our knowledge, this estimation of EE in MET during activities of daily living is the first data of young adults in Korea. These data could be used as a reference to modify the guidelines of physical activities for the age group examined in this study.

Physiological Responses During the Lower Body Positive Pressure Supported Treadmill Test

OBJECTIVE: To quantify changes in cardiopulmonary function using a lower body positive pressure supported (LBPPS) treadmill during the exercise tolerance test (ETT) in healthy subjects before applying the LBPPS treadmill in patients with gait problems. METHODS: We evaluated 30 healthy subjects who were able to walk independently. The ETT was performed using the Modified Bruce Protocol (stages 1–5) at four levels (0%, 40%, 60%, and 80%) of LBPPS. The time interval at each level of the LBPPS treadmill test was 20 minutes to recover to baseline status. We measured systolic blood pressure, diastolic blood pressure, peak heart rate (PHR), rating of perceived exertion (RPE), metabolic equivalents (METs), and oxygen consumption rate (VO₂) during each LBPPS condition. RESULTS: Systolic blood pressure increased as the LBPPS level was increased (40% to 80%). PHR, RPE, METs, and VO₂ were negatively associated with the LBPPS condition, although they were not always significant different among the LBPPS levels. The equation from a random effect linear regression model was as follows: VO₂ (mL/kg/min)=(2.75×stage)+(–0.14×LBPPS level)+11.9 (r²=0.69). CONCLUSION: Detection of the changes in physiological parameters during a submaximal ETT using the LBPPS system may be helpful for applying the LBPPS treadmill in patients who cannot perform the ETT due to gait problems, even at submaximal intensity.

Relationship between Changes in Fatigue and Exercise by Follow-Up Period / 가정의학회지

BACKGROUND: Fatigue is one of the most common presenting symptoms in primary care in Korea. In this study, we aimed to determine the effect of exercise intervention on the severity of fatigue of unknown medical cause during a period of follow-up. METHODS: We used the data collected from an outpatient fatigue clinic in Seoul National University Bundang Hospital. The study was conducted from March 3, 2010 to May 31, 2014. We measured the body mass index of each patient and evaluated variables including lifestyle factors (smoking, alcohol consumption, and regular exercise), quality of sleep, anxiety, depression, stress severity, and fatigue severity using questionnaires. A total of 152 participants who completed questionnaires to determine changes in fatigue severity and the effect of exercise for each period were evaluated. We used univariate analysis to verify possible factors related to fatigue and then conducted multivariate analysis using these factors and the literature. RESULTS: Of 130 patients with the complaint of chronic fatigue for over 6 months, over 90 percent reported moderate or severe fatigue on the Fatigue Severity Scale and Brief Fatigue Inventory questionnaires. The fatigue severity scores decreased and fatigue improved over time. The amount of exercise was increased in the first month, but decreased afterwards. CONCLUSION: There was no significant relationship between changes in the amount of exercise and fatigue severity in each follow-up period. Randomized controlled trials and a cohort study with a more detailed exercise protocol in an outpatient setting are needed in the future.

Actividad física y composición corporal en estudiantes universitarios de cultura física, deporte y recreación / Physical activity and body composition among college students of physical culture, sport and recreation

Introducción: La actividad física es un factor determinante de la salud relacionado con el estilo de vida y su práctica regular está asociada con disminución de enfermedades crónicas. Objetivos: Describir la cantidad de actividad física en los diferentes dominios (ocupacional, desplazamiento y tiempo libre), y establecer el índice de masa corporal y el porcentaje de grasa corporal de los estudiantes. Metodología: Estudio analítico, corte transversal realizado en estudiantes de pregrado de una facultad de cultura física, deporte y recreación. La actividad física fue determinada mediante Cuestionario Mundial de Actividad Física. Se evaluó la actividad física en los dominios ocupacional, desplazamiento y tiempo libre. Resultados: El 21.0% presentó sobrepeso y 3.6% obesidad, según índice de masa corporal. El 12.6% presentó exceso de grasa total corporal. El 98.8% de los estudiantes es activo físicamente y cumple con las recomendaciones de la Organización Mundial de la Salud sobre actividad física para la salud. El análisis estratificado del exceso de peso, actividad física y conducta sedentaria por semestre académico, evidencia mayor porcentaje sobrepeso u obesidad en los estudiantes que cursaban de sexto a décimo semestre. Conclusiones: La mayoría de estudiantes analizados son físicamente activos. Los estudiantes que se encontraban cursando la segunda mitad de la carrera presentan mayores porcentajes de exceso de peso. Evaluar el nivel de actividad física en estudiantes de cultura física resulta importante dado que representan un grupo de futuros profesionales enfocados hacia la promoción de estilos de vida saludables relacionados con adecuados niveles de actividad física.

Introduction: Physical activity is an important determinant of health-related lifestyle and its regular practice is associated with reduction of chronic diseases. Objectives: To describe the amount of physical activity in different domains (occupational, displacement and free time), and assess the Body Mass Index and body fat percentage of students. Methodology: An analytic, cross-sectional study was carried out in college students of a faculty of physical culture, sport and recreation. Physical activity was determined by Global Physical Activity Questionnaire. Physical activity in the occupational, displacement and free time domains, was assessed. Results: The prevalence of overweight was 21.0% andof obesity 3.6% according to body mass index. 12.6% had excess total body fat. 98.8% of students were physically active and comply with the recommendations of the World Health Organization on physical activity for health. Stratified analysis of excess weight, physical activity and sedentary behavior by semester, evidenced higher percentage overweight or obesity in sixth to tenth semester students than those from first to fifth semester. Conclusions: Most students analyzed were physically active. Students who were enrolled in the second half of the race had higher percentages of excess weight. To assess the level of physical activity in students of physical culture is important because they represent a group of future professionals focused on promoting healthy lifestyles related to adequate levels of physical activity.

A study on cardiovascular fitness of male medical students.

Background: Cardiovascular fitness has been found to be significantly compromised by obesity, whose prevalence is increasing rapidly. The present study aimed to assess the aerobic exercise performance in terms of maximum aerobic power (VO2 max) of the male students of North Bengal medical college in the age range of 18-22 years. Methods: The subjects were divided into two groups viz. control (N=52) and study (N=43) on the basis of Body Mass Index (BMI) and Waist Circumference (WC), according to the current Indian guidelines for obesity. The VO2 max was compared among the two groups. It was evaluated using the Bruce protocol, and also expressed in terms of ‘Metabolic equivalents’ (MET). Results: VO2 max exhibited significant negative correlation with BMI (r=0.75, P <0.000) and WC (r=0.72, P <0.000). VO2 max was higher for the normal group compared to the study group, and the mean difference was significantly different [P <0.05(0.000)]. Conclusion: The study thus showed that cardiovascular capacity is compromised by excess adiposity.

Limitações da utilização do equivalente metabólico (MET) para estimativa do gasto energético em atividades físicas / Limitations of using the metabolic equivalent (MET) to estimate energy expenditure in physical activities

A determinação do gasto energético total é extremamente importante no campo daciências da saúde, com a atividade física voluntária o componente mais variável. este trabalhocontextualiza equivalente metabólico (MET), um método simples e prático para estimar ogasto energético do exercício e da atividade física em adultos. O MET se baseia no descansovalor de consumo de oxigénio de 3,5 ml / kg / min, mas a origem exacta deste valor é desconhecido.Em contrapartida, estudos em populações heterogêneas e específicos (ou seja, obesos, idosos) apresentam menorvalores do que o valor padrão. Consequentemente, o gasto energético da atividade física voluntáriapode ser subestimada, uma vez que se baseiam na elevação (múltiplos) de consumo de oxigênioquando comparado com o estado de repouso. Neste contexto, estudos recentes sugerem que uma correção davalor de 1 MET através da equação de Harris-Benedict (3,5 ÷ estimada taxa metabólica de repouso[ml / kg / min]), fornece uma estimativa mais individualizada e precisa do gasto energéticomedido diretamente (calorimetria indireta). Este fator pode favorecer o melhor planejamento das nutricionalintervenções e treinamento físico. Os cálculos e estimativas estão sempre sujeitos a erros devidoàs variações físicas / biológicas entre os indivíduos e os fatores ambientais. Este fator podefavorecer o melhor planejamento de intervenções nutricionais e de treinamento físico. No entanto, não fazjustificar o uso de um valor universal (1 MET = 3,5 ml / kg / min) durante toda a população, o que resultaem estimativas inadequadas de gasto energético em atividades físicas. Por outro lado, a novaestudos devem ser realizados para que os fatores de correção podem ser propostos para populações específicas,dado que também há controvérsias entre as equações de predição da taxa metabólica de repouso.

Determining the total energy expenditure is extremely important in the field of health sciences, with the voluntary physical activity the most variable component. This work contextualizes metabolic equivalent (MET), a simple and practical method for estimating the energy expenditure of exercise and physical activity in adults. The MET is based on the resting oxygen consumption value of 3.5 mL/kg/min, but the exact origin of this value is unknown. In contrast, studies in heterogeneous and specific populations (i. e. obese, elderly) show lower values than the default value. Consequently, the energy expenditure in voluntary physical activity may be underestimated, since they are based in the elevation (multiples) of oxygen consumption when compared to the resting state. In this context, recent studies suggest a correction of the value of 1 MET through the Harris-Benedict equation (3.5 ÷ estimated resting metabolic rate [mL/kg/min]), provides a more individualized and accurate estimation of the energy expenditure directly measured (indirect calorimetry). This factor can favor the better planning of nutritional interventions and physical training. Calculations and estimates are always subject to errors due to physical/biological variations among individuals and environmental factors. This factor can favor the better planning of nutritional interventions and physical training. However, does not justify the use of a universal value (1 MET = 3.5 mL/kg/min) for entire population, which results in inadequate estimates of energy expenditure in physical activities. On the other hand, new studies must be carried out so that correction factors may be proposed for specific populations, given that are also controversies between the predictive equations of resting metabolic rate.

Obesity and Obesity-Related Lifestyles of Korean Breast Cancer Survivors

BACKGROUND: Obesity not only does increase the incidence of breast cancer, but also affects the course of treatment, recurrence and mortality. This study aims to evaluate on the obesity status of Korean breast cancer survivors and their obesity-related lifestyles. METHODS: The study included 125 Korean female breast cancer survivors aged over 19 year old enrolled in the 2009-11 Korean National Health and Nutrition Examination Survey. Women who answered 'yes' to the question 'have you ever been diagnosed breast cancer by a physician?' was defined as a breast cancer survivors. Height, weight, and waist circumference were measured and Body mass index (BMI) was calculated. Body fat percent was assessed by dual X-ray absorptiometry (DXA). Standardized surveys by trained interviewers were used to investigate survivors' obesity-related lifestyles such as physical activities, sleeping hours and nutrients intake. RESULTS: 48.4% of Korean breast cancer survivors were obese. 44.7% had abdominal obesity and 89.2% had body fat percent over 30. Their physical activity level was generally low; only 22.5% maintained health-enhancing level of physical activities. Fat intake (14.4 [0.8] %) was as low and carbohydrate intake (74.2 [1.2] %) was high. However, daily dietary fiber intake was low (10.5 [1.1] g). Factors that were found to be significantly related with obesity in Korean breast cancer survivors were low education level (P=0.042), smoking (P<0.001), having chronic diseases (P=0.002) and short sleeping hours (P<0.001). CONCLUSIONS: It is mandatory for physician to evaluate obesity status of breast cancer survivors as soon as their diagnosis and give proper intervention to maintain healthy weight and healthy obesity related lifestyle.

Demanda metabólica das atividades de militares da marinha: o avançar da carreira e a redução da exigência física / Metabolic demand of navy militaries activities: advancing career and the reduction of physical demand

Os objetivos deste estudo foram identificar as principais atividades comuns às rotinas ocupacional e de condicionamento físico dos militares do Centro de Educação Física da Marinha do Brasil e estimar a demanda metabólica (DM) destas atividades. Cento e sessenta e um militares (n = 149 M e 12 F) com idade entre 19 e 47 anos (30,6 ± 7,8 anos) foram divididos em três grupos diferentes: marinheiros, soldados e cabos (G1), sargentos e suboficiais (G2) e oficiais (G3). A estimativa da DM foi realizada através de uma lista de atividades adaptada do Compêndio de Atividades Físicas. O questionário foi formatado em uma plataforma na WEB (www.surveymonkey.com) para que os sujeitos respondessem digitalmente. As atividades de condicionamento foram classificadas como moderadas (5,8 e 5,9 MET), para G2 e G3, respectivamente, e vigorosas (6,1 MET), para G1. As atividades da rotina ocupacional também foram classificadas como moderadas (2,7 a 3,8 MET). Foram observadas diferenças significativas entre as médias de DM das atividades da rotina ocupacional dos três grupos. Observou-se uma relação inversa entre a DM das atividades da rotina ocupacional e o avançar da carreira militar. Nas atividades de condicionamento, a redução da DM foi relacionada à idade, mas não necessariamente aos círculos hierárquicos dos militares. Conclui-se que o avançar da carreira militar leva a uma rotina ocupacional mais sedentária, o que pode contribuir para o aumento do risco de desenvolvimento de doenças induzidas pela hipocinesia.

The purposes of this study were to identify the main usual activities of the occupational and physical fitness routines of militaries from the Physical Education Center of the Brazilian Navy and to estimate their metabolic demand (MD). One hundred and sixty one militaries (n = 149 M and 12 F) aged 19 to 47 years (30.6 ± 7.8 years) were divided into three different groups: sailors, soldiers and corporals (G1), sergeant and petty o?cers (G2) and o?cers (G3). The MD estimate was performed through a list of activities adapted from the Compendium of Physical Activities. The questionnaire was available in a web platform (www.surveymonkey.com) so that individuals respond digitally. The conditioning activities were classified as moderate (5.8 and 5.9 METs), for G2 and G3, respectively, and vigorous (6.1 METs), for G1. The activities of the occupational routines were also classified as moderate (2.7 to 3.8 METs). Significant differences were observed among the means of the MD for the occupational routines of the three different groups. There was an inverse relationship between the MD of the activities of the occupational routine and the military career advancing. In conditioning activities, the reduction of MD was related to the age but not necessarily to the military ranks. It was concluded that advancing military career leads to a more sedentary occupational routine, which may contribute to increased risk of developing hypokinesia-induced diseases.

The impact of motivational interventions for increasing physical activity / Impacto da intervenção motivacional no aumento do nível de atividade física

Objective: To assess whether incentives for practicing regular physical activities in fact help raising the frequency of exercising. Methods: Male and female subjects undergoing two to three assessments in the Check-Up Unit of Hospital Israelita Albert Einstein (HIAE) were evaluated by noting any increase in levels of physical activity, improvements in mean metabolic unit numbers, and the sensitization index. The International Physical Activity Questionnaire was applied to assess the sample. Results: There were 1,879 subjects - 1,559 (83%) males and 320 (17%) females - aged 20 to 76 years (mean age = 45.8 years, standard deviation ± 8.8) who underwent a Continued Health Review at the Center for Preventive Medicine of the HIAE, Check-Up Unit, Jardins. Initially, over half of the sample was insufficiently active (sedentary or poorly active); there were more women than men in this group. After the health review, most subjects increased their level of physical activity; this increase was higher among women. Males encouraged three times to exercising showed better results (increased level of physical activity) as compared to males encouraged twice for exercising. The best results in females were found in the group that went through two evaluations. This result is due to the fact that the sample of females comprising the group that received incentives on three occasions was small. This was also the only group that showed no increase in mean metabolic units. The sensitization index assessment in the overall sample was very satisfactory, as the expected results were achieved. Conclusions: These results show that motivational interventions are effective for raising the level of physical activity. We concluded that to encourage the practice of regular physical activity through information programs about its health benefits is very important.

Objetivo: Verificar se a proposta de incentivo à prática regular de atividade física colabora para o aumento dos níveis de atividade física. Métodos: Foi realizada uma avaliação entre os grupos de homens e mulheres que passaram por duas ou três avaliações na Unidade de Check-Up do Hospital Israelita Albert Einstein (HIAE), comparando-se a melhora no nível de atividade física, a melhora da média do número de unidades metabólicas e o Índice de Sensibilização. Toda a amostra foi avaliada por meio do Questionário Internacional de Atividade Física. Resultados: A amostra foi constituída por 1.879 indivíduos, sendo 1.559 (83%) do sexo masculino e 320 (17%) do sexo feminino, com idades variando de 20 a 76 anos, idade média de 45,8 anos (desvio padrão ± 8,8) submetidos à Revisão Continuada de Saúde no Centro de Medicina Preventiva do HIAE, Unidade Check-Up, Jardins. No início do nosso estudo, mais da metade da nossa amostra era de indivíduos insuficientemente ativos (sedentários + pouco ativos), sendo que, quando dividida a amostra entre os gêneros, este número foi maior entre as mulheres. Após a reavaliação, foi possível constatar que grande parte dos indivíduos obteve aumento no nível de atividade física, sendo que entre as mulheres este aumento foi maior. O grupo de homens que recebeu a proposta de incentivo à atividade física por três vezes obteve melhores resultados em relação aos níveis de atividade física que o grupo de homens que recebeu a proposta de incentivo por duas vezes. No grupo das mulheres, o resultado foi melhor no grupo avaliado duas vezes. Este resultado se deve ao número reduzido da amostra de mulheres do grupo que recebeu a proposta por três vezes. Este grupo também foi o único que não apresentou aumento do número da média de unidades metabólicas. A avaliação do Índice de Sensibilização na amostra geral foi muito satisfatória, atingindo os resultados esperados. Conclusões: Estes resultados demonstram que a Intervenção Motivacional é uma ferramenta eficaz para a promoção da atividade física. Conclui-se que é de grande importância o incentivo da prática regular de atividade física mediante programas de informação de seus benefícios à saúde.

Does leisure-time physical activity in early adulthood predict later physical activity? Pro-Saude Study / Atividade física de lazer no início da vida adulta prediz a atividade física posterior? Estudo Pró-Saúde

INTRODUCTION: Leisure-Time Physical Activity (LTPA) is a health behavior that is considered relatively stable over the course of life; this life-long habit seems to be shaped during youth and early adulthood. LTPA is one of the few healthy behaviors more prevalent among men than among women. METHODS:Data from 3,199 participants of the Pro-Saude Study were analyzed - a cohort of employees of a university in Rio de Janeiro, collected with a self-reported multidimensional questionnaire. The association between LTPA in early adulthood and later was investigated using multinomial logistic regression, with estimated odds ratios (OR), considering three outcome categories: inactive, insufficiently active, and active. Past LTPA was grouped into three categories: never/rarely (reference category), sometimes and frequently/always. Estimates were adjusted for: age; participants' schooling, their father's and mother's schooling, and color/race. RESULTS:Analysis shows men who engaged in LTPA sometimes and almost always/always in early adulthood had an OR= 1.42 (95 percent CI: 0.70-2.89) and OR= 3.33 (95 percent CI: 1.82-6.10), respectively, of being physically active in later adulthood than those who did not engage in LTPA. Among women, the corresponding odds ratios were lower: OR = 1.19 (95 percent CI: 0.79-1.79) and OR =1.42 (95 percent CI: 1.00-2.04). CONCLUSION:LTPA during early adulthood is associated with physical activity later in adulthood, and this association is stronger in men than in women. Public policies that encourage LTPA among youth, with specific efforts directed at women, could increase the proportion of physically active adults.

INTRODUÇÃO: Atividade física é um comportamento de saúde relativamente estável, em geral determinado no início da vida adulta. Atividade física de lazer (AFL) é um dos poucos comportamentos benéficos à saúde mais prevalente entre homens que entre mulheres. MÉTODOS: Foram analisados dados de 3.199 participantes do Estudo Pró-Saúde - coorte de funcionários de universidade no Rio de Janeiro, coletados por meio de questionário multidimensional e autopreenchível. A associação entre AFL no início da vida adulta e posteriormente foi analisada com uso de regressão logística multinomial, com estimativas de razões de chance (odds ratio) e seus respectivos intervalos de 95 por cento de confiança considerando três categorias de desfecho: sedentários, insuficientemente ativos e ativos. AFL pregressa foi agrupada em 3 categorias: nunca/raramente (categoria de referência), às vezes, quase sempre/sempre. Estimativas foram ajustadas por idade, escolaridade, escolaridade dos pais e cor/raça. RESULTADOS:Homens que se engajavam em AFL às vezes e quase sempre/sempre no início da vida adulta tiveram, respectivamente, OR = 1,42 (IC 95 por cento: 0,70-2,89) e OR = 3,33 (IC 95 por cento: 1,82-6,10) de ser fisicamente ativos em idade posterior do que os sedentários. Entre as mulheres, os odds ratios foram menores: OR = 1,19 (IC 95 por cento: 0,79-1,79) e OR =1,42 (IC 95 por cento: 1,00-2,04). CONCLUSÃO:A prática de AFL durante o início da vida adulta apresentou associação com atividade física posterior, e essa associação foi mais expressiva em homens do que em mulheres. Políticas públicas que encorajem a AFL entre os jovens, com esforços específicos direcionados às mulheres, poderiam aumentar a proporção de adultos fisicamente ativos.