Blood glucose threshold determination is stage length dependent

Aim: This study aimed to verify whether different stage length affects the intensity of the Blood Glucose Threshold (BGT), and the agreement between evaluators for BGT determination. Methods: Fourteen subjects attended the laboratory during the first session to perform anthropometric measures and become familiar with procedures. In the following three sessions, subjects performed an incremental test on the ergometer bicycle and in each test a different protocol was performed in randomized order (1, 3- and 5-min stage) to identify BGT. Three different evaluators determined the BGT. Results: Our data show that the BGT is stage length-dependent (1, 3- and 5-min; P<0.0001). The intraclass correlation coefficient showed that there was a strong correlation among evaluators for all protocols (ICC = 0.8 to 1 min; ICC = 0.8 to 3 min; and ICC 0.9 to 5 min). However, one evaluator determined the BGT at a higher intensity than others. The peak load was lower at long stage length. Conclusion: We concluded that stage length influences the BGT intensity determination. The BGT presents a good agreement among evaluators. However, a minimum of two evaluators is needed for BGT determination. The peak load is affected by stage length.(AU)

Influence of the hydration on autonomic modulation and cardiorespiratory parameters of coronary heart disease patients submitted to a cardiovascular rehabilitation session: crossover clinical trial protocol

Abstract Aims: The influence of fluid replacement, realized during and after the exercise on individuals with coronary artery disease (CAD) remains poorly understood. To investigate the influence of hydration on cardiac autonomic modulation, cardiorespiratory parameters and perceived exertion and discommodity, of coronary heart patients submitted to cardiac rehabilitation (CR) session. Methods: This cross-over clinical trial, will recruit 31 adults with more than 45 years old, participants of a cardiovascular rehabilitation program, with CAD diagnosis. The participants will be submitted to an experimental protocol composed of three phases: I) Maximal stress test; II) Control protocol (CP); and III) Hydration protocol (HP). The CP and HP will consist of 10 min of rest in a supine position, 15 min of warming, 40 min of treadmill exercise, 5 min of cooling down and 60 min of rest in a supine position. In the HP, the participants will be hydrated with mineral water, based on the bodyweight reduction of the CP. The water intake will be divided into eight equal portions, offered during the treadmill exercise and recovery period. On CP and HP will be evaluated linear and nonlinear indices of heart rate variability, the heart rate, systolic blood pressure, diastolic blood pressure, respiratory rate, oxygen partial saturation, perceived exertion and discommodity on specifics moments. Conclusion: The results of this study will allow us to identify if the proposed protocol will be able to positively influence the outcomes and, consequently, if could be implement in the clinical practice.

Heart rate responses of a master athlete during ultra-endurance swimming

Abstract Aim: Swimming races outside swimming pools take place all over the world, but studies focusing on their physiological aspects are scarce. In fact, rules forbid any direct contact with swimmers during sanctioned events. This case report presents heart rate responses of a master athlete during an ultra-endurance open water solo swim and analyzes results based on a prior cardiopulmonary exercise test. Methods: The swimmer performed a cardiopulmonary exercise test on a treadmill, following a ramp protocol, with continuous electrocardiogram recording. The athlete performed a 36 km swimming race with continuous heart rate recording. Description of swimming heart rate accordingly to heart rate training zones and correlation analysis between HR and swim speed was assessed. Results: The athlete swam the 36 km event in 11 hours, 16 minutes and 15 seconds. Most of the swim time was spent in training zone 3 (55%), and only 2% of race time was spent in zone 5. Swimming speed (3.2 ± 0.7 km/h) failed to correlate with HR during the event (r2 = 0.1334, p > 0.05). Conclusion: Although HR did not correlate with swimming speed it successfully indicated exercise intensity during this 36 km event. These results can be used in the preparation and monitoring of other solo long-distance swimmers.

Performance comparison in the Wingate test between standing and seated positions in competitive cyclists

Abstract Aims: The current study aimed to compare the anaerobic power output through the Wingate test in different positions, i.e., standing and seated, and identify the relationship between power-output and body mass. Methods: Eleven male competitive cyclists (age: 30.3 ± 4.7 years; body mass: 73.7 ± 7.7 kg; body fat: 11.3 ± 4.2%) were submitted to two sessions of the Wingate test (WT) in different positions, on different days. Results: The peak power (W), average power (W), relative peak power (W·kg-1), relative average power (W·kg-1), average cadence (rpm), and average velocity (km·h-1) presented significant differences in the standing position compared with the seated position (p < 0.05), 1155 ± 130 vs. 1082 ± 182 (W), 875 ± 96 vs. 818 ± 116 (W), 15.9 ± 1 vs. 15.0 ± 2 (W kg-1), 12.1 ± 1 vs. 11.3 ± 1 (W kg-1), 117.5 ± 7 vs. 109.8 ± 10 (rpm), 37.0 ± 2 vs. 34.6 ± 3 (km·h-1), respectively. However, when controlled the body mass, the differences in variables power output ceased to exist (p > 0.05). The fatigue and peak heart rate (bpm) indices did not present significant differences between the tests (p > 0.05). Conclusions: Sprint performance was improved when the WT was performed in a standing position in competitive cyclists. The study also reports the important relationship between body mass and anaerobic production capacity in the WT, emphasizing that it is desirable an increase in lean body mass and a reduction in fat mass, similar in competitions. We suggest that, for anaerobic assessment in cyclists, the standing position should be used during the WT, to determine the maximum power-output capacity.

Exercise Training Improves Heart Rate Recovery after Exercise in Hypertension

Abstract Aim: This study tested the hypothesis that: 1- the exercise training would improve the heart rate recovery (HRR) decline after maximal exercise test in hypertensive patients and; 2- the exercise training would normalize HRR decline when compared to normotensive individuals. Methods: Sixteen hypertensive patients were consecutively allocated into two groups: Exercise-trained (n = 9, 47±2 years) and untrained (n = 7, 42±3 years). An exercise-trained normotensive group (n = 11, 41±2 years) was also studied. Heart rate was evaluated by electrocardiogram. The autonomic function was evaluated based on heart rate changes on the first and the second min of recovery after the maximal exercise test. Exercise training consisted of three 60-minute exercise sessions/week for 4 months. Results: In hypertensive patients, exercise training significantly increased the HRR decline in the first (-19±2 vs. -34±3 bpm, P = 0.001) and second (-33±3 vs. -49±2 bpm, P = 0.006) minutes after the maximal exercise test. In addition, after exercise training, the initial differences in the HRR decline after exercise between hypertensive patients and normotensive individuals were no longer observed (first minute: -34±3 vs. -29±3 bpm, P = 0.52, and second minute: -49±2 vs. -47±4 bpm, P = 0.99). Conclusion: Hypertension causes a delay in HRR after the maximal exercise test yet the exercise training normalizes HRR during the post-exercise period in hypertensive patients.

Aptidão física relacionada à saúde de policiais militares da Paraíba / Health­related physical fitness of military police officers in Paraiba, Brazil

Introdução: Boas relações entre os componentes da aptidão física relacionada à saúde (AFRS) melhoram o desempenho da atividade ocupacional de policiais militares. Objetivo: Verificar a relação entre componentes da AFRS em policiais militares do Batalhão de Operações Policiais Especiais (BOPE) e do Batalhão de Policiamento de Trânsito (BPTRAN). Método: Participaram do estudo 47 policiais com idades entre 26 e 49 anos do sexo masculino fracionados em dois grupos: BOPE (n=25) e o BPTRAN (n=22). Foi realizada uma bateria de testes: medidas antropométricas, teste de sentar-e-alcançar no banco de Wells, teste de abdominal de 1 minuto, teste de flexão dos cotovelos e teste vai-e-vem de 20 metros, para avaliar os componentes morfológico, cardiorrespiratório e neuromuscular da AFRS. Resultados: Ambos os grupos obtiveram de moderada à forte correlação negativa significante em relação à circunferência de cintura (CC), índice de massa corpórea (IMC) e percentual de gordura (PG) com a resistência muscular localizada (RML) (r=-0,589; r=-0,404; r=-0,637) e a força muscular dinâmica (FD) (r=0,592; r=-0,416; r=-0,651) (p<0,05). Contudo, houve correlações positivas e negativas significantes entre o consumo máximo de oxigênio (VO2 máx) e as variáveis CC, IMC, PG e RML (p<0,05), exceto para flexibilidade no BOPE. Conclusão: Existe uma forte correlação entre os componentes morfológico, cardiorrespiratório e neuromuscular, exceto para a flexibilidade em PMs do BOPE. Tal fato permite afirmar que a AFRS é uma variável global

Background: An adequate relationship among health­related physical fitness (HRPF) components improve the professional performance of military police officers (MOPs). Objective: To investigate the correlation among HRPF components for Special Police Operations (BOPE) and Traffic Police (BPTRAN) Battalion MOPs. Method: The sample comprised 47 male MOPs aged 26 to 49 years old divided in two groups BOPE (N=25) and BPTRAN (n=22). The participants were subjected to a test battery­anthropometric measurements, sit­and­ reach test, 1-minute sit­up test, elbow flexion test, and 20­meter shuttle run test­for evaluation of the HRPF morphological, cardiorespiratory and neuromuscular components. Results: Both groups exhibited moderate­to­strong correlation of waste circumference (WC), body mass index (BMI) and body fat percentage (BFP) with localized muscle resistance (LMR) (r=-0.589; r=-0.404; r=-0.637) and dynamic muscle strength (DMS) (r=0.592; r=-0.416; r=-0.651) (p<0.05). Significant positive and negative correlation was found between maximum oxygen consumption and WC, BMI, BFP and LMR (p<0.05) but not with flexibility for BOPE. Conclusion: There was strong correlation between the HRPF morphological, cardiorespiratory and neuromuscular components, except for flexibility among BOPE MPOs. The study findings allow inferring that HRPF is a global variable

Evaluation of maximal lactate steady state in middle-aged hypertensive women

Abstract AIM The aim of this study was to investigate the lactate response in physically inactive hypertensive women submitted to the treadmill maximal lactate steady state (MLSS) protocol. METHODS Twenty-two hypertensive women (40 - 64 years) performed a familiarization period of walking on the treadmill following by one incremental test for estimating the initial workload for exercise testing. MLSS protocol was composed by walking in a treadmill during thirty minutes with fixed velocity in 5.5 km/h. Incline was used for determination of the intensity of each volunteer. Blood samples were collected from the ear lobe in the rest period, minute 10th and at the end of the test (minute 30th or at exhaustion time point) for lactate analysis. RESULTS Hypertensive women showed a lower lactate concentration at MLSS (3.25 ± 0.81 mmol/L) as compared with data obtained in the literature (4 mmol/L), approximately 18.8%. Neither inclines nor age affected MLSS parameters in the population. A positive and strong correlation was found between incline and MLSS, as well as incline and lactate level at minute 30th, even when adjusted by age factor. CONCLUSION Physically inactive hypertensive women show a lower MLSS than the average established in the literature but within the range of variations previously reported. Furthermore, a higher MLSS incline correlates positive and directly with higher lactate concentrations for the same aerobic capacity regardless of age.

Evaluación de la actividad física en pacientes con enfermedad pulmonar obstructiva crónica / Tools for physical activity assessment in chronic obstructive pulmonary disease

The prevalence and mortality of chronic obstructive pulmonary disease (COPD) is increasing in Chile, constituting a public health problem. Pulmonary and systemic consequences of COPD affect physical activity, as the disease progresses. There are multiple means for physical activity assessment, from low cost and easily applicable questionnaires to sophisticated laboratory tests. Physical inactivity is a modifiable risk factor for morbidity and mortality in patients with COPD. Physical activity interventions not only contribute to decrease the likelihood of mortality, but also protect from comorbidities, especially cardiovascular ones. It also plays a major role avoiding functional limitations of these subjects. Dyspnea and fatigue render exercise as an unpleasant activity for most patients with COPD. If psychological alterations such as anxiety and depression are summed, these patients drift towards an inactive lifestyle. This article analyzes several tools available to assess physical activity is patients with COPD, useful in clinical practice.

Avaliação da força muscular respiratória e capacidade funcional em pacientes com fibrose cística / Evaluation of respiratory muscle strength and functional capacity in patients with cystic fibrosis

Objetivo: Correlacionar a força muscular respiratória e a capacidade funcional em pacientes com FC. Métodos: Estudo transversal em adultos com fibrose cística. Os dados amostrais foram catalogados no Microsoft Office Excel 2007 e as variáveis analisadas pelo SPSS versão 20.0 através do teste t de Student e do coeficiente de Spearman. O nível de significância adotado foi p < 0,05. Resultados: Foram avaliados 35 pacientes com fibrose cística (44,6 ± 19,0 anos), grande parte dos pacientes de FC (n=26) não apresentaram fraqueza da musculatura inspiratória (PImáx -90,7 ± 27,4 cmH2O). Não foi encontrada estatística significativa apenas entre os pacientes adultos e idosos. Houve correlação positiva entre PImáx, PEmáx e teste de caminhada de 6 minutos (TC6) nos participantes com fraqueza muscular respiratória e nos idosos. Houve diferença estatisticamente significativa entre as médias da distância percorrida no TC6 e das pressões respiratórias máximas com a média do que foi previsto para estas variáveis. Conclusão: Todos os grupos apresentaram limitação da força respiratória e da capacidade funcional. As correlações entre as pressões respiratórias com o TC6 foram baixas e pequenas nos adultos e indivíduos sem fraqueza muscular respiratória; moderadas à alta nos idosos; pequenas à moderada nas mulheres; pequenas e negativas nos homens; e, altas naqueles com fraqueza muscular respiratória

Objective: To correlate the respiratory muscle strength and functional capacity in patients with CF. Method: Cross-sectional study in adults with cystic fibrosis. Sampling data were cataloged in Microsoft Office Excel 2007 and the variables analyzed by SPSS version 20.0 using the Student t test and the Spearman coefficient. The level of significance adopted was p < 0.05. Results: We assessed 35 patients with cystic fibrosis (44.6 ± 19.0 years), the great majority of patients in FC (n=22) did not present weakness of the inspiratory muscles (MIP -90,7 ± 27.4 cmH2O). It was not found statistically significant differences only between the adult and elderly patients. There was a positive correlation between MIP and MEP and a six-minute walk test (6MWT) in participants with respiratory muscle weakness and in the elderly. There was statistically significant difference between the averages of the distance covered on the 6MWT and the maximal respiratory pressures with the average of what was envisaged for these variables. Conclusion: All groups presented limitation of respiratory strength and functional capacity. The correlations between the respiratory pressures with the 6MWT were low and small in adults and individuals without respiratory muscle weakness; moderate to high in the elderly; small to moderate in women; small and negative in men; and high in patients with respiratory muscle weakness

Como determinar a velocidade inicial da esteira no treinamento aeróbio de hemiparéticos crônicos? / How to determine the initial treadmill speed for the aerobic training of chronic hemiparetics?

Objetivo: Investigar os critérios para estabelecer a velocidade inicial da esteira e viabilizar um treinamento motor funcional ou cardiorrespiratório em hemiparéticos crônicos. Métodos: Foram recrutados 15 hemiparéticos crônicos determinados pelo Lower Extremity Motor Coordination Test (LEMOCOT) e submetidos à avaliação da marcha pelo Time up and go (TUG), Teste de Esforço Máximo (TES) e Teste de velocidade de marcha de 10 metros (TV10M). Resultados: A análise dos valores do LEMOCOT demonstrou uma média de 26,87 ± 9,76 acertos nos alvos no lado não parético e 15,40 ± 8,46 no lado parético. No TUG verificou-se a velocidade média de 0,37 ± 0,14 m/s e no TV10M 0,63 ± 0,23 m/s. No TES a velocidade média foi 0,60 ± 0,25 m/s. Houve correlação forte e significante entre os valores de TUG, TV10M e TEX. Conclusão: O TES e TV10M são testes adequados para serem utilizados como critério de elegibilidade da velocidade inicial para treinos aeróbios, todavia o TES é capaz de revelar o tempo em que o paciente consegue manter a marcha. O TUG não revelou ser um bom instrumento para estabelecer a velocidade inicial do treinamento

Objective: To investigate the criteria for establishing the initial treadmill speed and create a functional or cardiorespiratory motor training for hemiparetic individuals. Methods: Fifteen chronic hemiparetic individuals were recruited and qualified by the Lower Extremity Motor Coordination Test (LEMOCOT) and submitted to gait evaluation through the Timed Up and Go (TUG), Stress Test (ST), and the 10-Meter Walk Test (10MWT). Results: The analysis of the LEMOCOT results showed a mean of 26.87 ± 9.76 target hits for the non-paretic side and 15.40 ± 8.46 for the paretic side. In the TUG, the average speed of 0.37 ± 0.14 m/s was found and in the 10MWT, 0.63 ± 0.23 m/s. In the ST the average speed was 0.60 ± 0.25 m/s. There was strong and significant correlation between the TUG, 10MWT, and ST values. Conclusion: The ST and 10MWT are suitable tests to be used as eligibility criteria for the initial speed of aerobic trainings, however the ST is able to reveal the time for which the patient is able to maintain the gait. The TUG did not prove to be a good instrument to establish the initial training speed

Screening for physical inactivity among adults: the value of distance walked in the six-minute walk test. A cross-sectional diagnostic study / Triagem para inatividade física em adultos: o valor da distância percorrida no teste de caminhada de seis minutos. Um estudo transversal diagnóstico

ABSTRACT: CONTEXT AND OBJECTIVES: Accelerometry provides objective measurement of physical activity levels, but is unfeasible in clinical practice. Thus, we aimed to identify physical fitness tests capable of predicting physical inactivity among adults. DESIGN AND SETTING: Diagnostic test study developed at a university laboratory and a diagnostic clinic. METHODS: 188 asymptomatic subjects underwent assessment of physical activity levels through accelerometry, ergospirometry on treadmill, body composition from bioelectrical impedance, isokinetic muscle function, postural balance on a force platform and six-minute walk test. We conducted descriptive analysis and multiple logistic regression including age, sex, oxygen uptake, body fat, center of pressure, quadriceps peak torque, distance covered in six-minute walk test and steps/day in the model, as predictors of physical inactivity. We also determined sensitivity (S), specificity (Sp) and area under the curve of the main predictors by means of receiver operating characteristic curves. RESULTS: The prevalence of physical inactivity was 14%. The mean number of steps/day (≤ 5357) was the best predictor of physical inactivity (S = 99%; Sp = 82%). The best physical fitness test was a distance in the six-minute walk test and ≤ 96% of predicted values (S = 70%; Sp = 80%). Body fat > 25% was also significant (S = 83%; Sp = 51%). After logistic regression, steps/day and distance in the six-minute walk test remained predictors of physical inactivity. CONCLUSION: The six-minute walk test should be included in epidemiological studies as a simple and cheap tool for screening for physical inactivity.

RESUMO: CONTEXTO E OBJETIVOS: A acelerometria fornece medida objetiva do nível de atividade física, porém não é viável na prática clínica. Assim, foram investigados testes de aptidão física capazes de predizer inatividade física em adultos. DESENHO E LOCAL: Estudo de teste diagnóstico, desenvolvido em laboratório universitário e uma clínica de diagnósticos. MÉTODOS: 188 participantes assintomáticos tiveram o nível de atividade física avaliado por acelerometria, ergoespirometria em esteira, composição corporal por bioimpedância, função muscular isocinética, equilíbrio postural em plataforma de força e teste de caminhada de seis minutos. Foram realizadas análise descritiva e regressão logística múltipla, incluindo idade, sexo, consumo de oxigênio, gordura corporal, centro de pressão, pico de torque de quadríceps, distância percorrida no teste de caminhada de seis minutos e passos/dia no modelo como preditores da inatividade física. Adicionalmente, foram determinadas a sensibilidade (S), especificidade (Sp) e área abaixo da curva dos principais preditores por meio de curvas de característica de operação do receptor. RESULTADOS: A prevalência da inatividade física foi 14%. O número médio de passos/dia (≤ 5357) foi o melhor preditor da inatividade física (S = 99%, Sp = 82%). O melhor teste de aptidão física foi a distância no teste de caminhada de seis minutos e ≤ 96% dos valores preditos (S = 70%; Sp = 80%). A gordura corporal > 25% também foi significativa (S = 83%, Sp = 51%). Após regressão logística, passos/dia e a distância no teste de caminhada de seis minutos permaneceram preditores da inatividade física. CONCLUSÃO: O teste de caminhada de seis minutos deve ser incluído em estudos epidemiológicos como ferramenta simples e barata para triagem da inatividade física.

Influence of treadmill training in dual-task gait in people with Parkinson's Disease: a case report / Influencia del entrenamiento en cinta rodante em la marcha de doble tarea en indivíduos con la enfermedad de Parkinson: um estúdio de caso / Influência do treino em esteira na marcha em dupla tarefa em indivíduos com Doença de Parkinson: estudo de caso

The loss in the automaticity of gait hinders the performance of concurrent activities - Dual Task (DT) - in individuals with Parkinson's disease (PD). One hypothesis for the negative interference of DT on gait is related to the limitation of attention resources in the brain for different activities. When the automation of a task occurs, the negative interference of DT on the gait can be minimized. Because the treadmill promotes automaticity of a better locomotion pattern, due to the repetition that promotes motor learning, the study sought to investigate whether treadmill training can improve the performance of gait on DT in people with PD. Three individuals were evaluated in the on-phase of the antiparkinsonian medication regarding the kinematics (Qualisys Motion Capture System) while in gait, simultaneously performing cognitive activities. Subsequently, the subjects performed a 20-minute workout on the treadmill and were reassessed during gait in cognitive activities. There were increases in the length of the cycle (p=0.01), the length of the step (p=0.01) and in total swing time (p=0.03), and a decrease in the total length of support (p=0.03). These results indicate that treadmill training can promote improvement in the performance of DT on gait in individuals with PD. Longitudinal studies with this focus of research are needed.

La pérdida en el automatismo de la marcha dificulta la realización de actividades simultáneas - Doble Tarea (DT) - en personas con enfermedad de Parkinson (EP). Una hipótesis para la interferencia negativa de la DT en la marcha está relacionada con la limitación de recursos cerebrales de atención para diferentes actividades. Cuando se produce la automatización de una de las tareas, la interferencia negativa de la DT sobre la marcha podrá ser minimizada. Como la cinta de correr promueve la automaticidad de un mejor patrón locomotor, debido a la repetición que favorece el aprendizaje motor, el estudio trató de investigar si el entrenamiento en cinta de correr puede mejorar el desempeño de marcha en DT en personas con EP. Tres individuos fueron evaluados en la fase on del medicamento antiparkinsoniano en cuanto a la cinemática (Qualisys Motion Capture System), mientras se realizaba la marcha simultáneamente a actividades cognitivas. Posteriormente, los individuos realizaron un entrenamiento de 20 minutos en la cinta y fueron evaluados de nuevo durante la marcha en actividades cognitivas. Hubo aumentos en longitud de la pasada (p=0,01), la longitud del paso (p=0,01) y en el tiempo total del abalanzar (p=0,03) y una disminución de en tiempo total de apoyo (p=0,03). Estos resultados indican que el entrenamiento en cinta puede promover la mejora en el rendimiento de marcha en DT en personas con EP, y que se necesitan estudios longitudinales con este enfoque de investigación.

A perda na automaticidade da marcha dificulta a realização de atividades concorrentes - Dupla Tarefa (DT) - em indivíduos com Doença de Parkinson (DP). Uma hipótese para a interferência negativa da DT sobre a marcha está relacionada à limitação de recursos cerebrais atentivos para as diferentes atividades. Caso ocorra a automatização de uma das tarefas, a interferência negativa da DT sobre a marcha poderá ser minimizada. Como a esteira promove automaticidade de um melhor padrão locomotor, devido à repetição que favorece a aprendizagem motora, o estudo buscou investigar se o treino em esteira pode melhorar o desempenho de marcha em DT em pessoas com DP. Três indivíduos foram avaliados na fase on do medicamento antiparkinsoniano quanto à cinemetria (Qualisys Motion Capture System), enquanto realizavam a marcha simultaneamente a atividades cognitivas. Posteriormente, os indivíduos realizaram um treino de 20 minutos na esteira e foram reavaliados durante a marcha em atividades cognitivas. Houve aumentos no comprimento da passada (p=0,01), no comprimento do passo (p=0,01) e no tempo total de apoio (p=0,03). Esses resultados indicam que o treino em esteira pode promover melhora no desempenho de marcha em DT em indivíduos com DP, sendo necessários estudos longitudinais com esse foco de investigação.

La evolución del valor pronóstico de la prueba de esfuerzo cardiopulmonar en los pacientes con insuficiencia cardíaca / The evolution of the prognostic value of CPX in patients with heart failure

Hace 20 años, en el importante estudio de Donna Mancini, se demostró el valor pronóstico de la prueba de esfuerzo cardiopulmonar (PECP) en pacientes con insuficiencia cardíaca. En ese ensayo se evaluó la utilidad del consumo máximo de oxígeno para definir el riesgo de mortalidad en una cohorte de 114 enfermos con insuficiencia cardíaca. La repercusión de los resultados iniciales influyó sobre la práctica clínica durante más de una década, durante la cual el consumo máximo de oxígeno era en general la única variable de la PECP que se consideraba para la estratificación del riesgo. A lo largo de los últimos 20 años, se ha demostrado en gran cantidad de investigaciones la importancia de otras variables de la PECP en el pronóstico. Los restantes parámetros relevantes de la PECP en la insuficiencia cardíaca incluyen los índices de eficacia ventilatoria (pendiente VM/CO2, presión parcial de dióxido de carbono en el aire espirado, ventilación oscilante en el ejercicio), frecuencia cardíaca, respuesta electrocardiográfica y de otros parámetros hemodinámicos, y la sintomatología. Entre los investigadores que evalúan la PECP en pacientes con insuficiencia cardíaca, se reconoce que el abordaje multivariado debe aplicarse para una óptima definición del pronóstico. Los clínicos responsables del tratamiento de los pacientes con insuficiencia cardíaca han comenzado a aplicar este enfoque. En esta revisión, se describe la evolución del uso de la PECP en los sujetos con insuficiencia cardíaca en estos 20 años.

Efecto del ejercicio prescrito no controlado sobre el perfil de condición física en brigadistas universitarios / The effect of prescribing an unsupervised exercise program on the fitness profile of university students participating in an emergency response brigade

Objetivos Determinar el efecto del ejercicio prescrito, no supervisado y la consejería en actividad física sobre la condición física y el nivel de actividad física de brigadistas voluntarios. Metodología Un total de 42 voluntarios participaron de un programa de ejercicio de 12 semanas. Se realizaron mediciones antes y después de variables como: peso, índice de masa corporal, porcentaje graso, perímetro de cintura, consumo de oxígeno, flexibilidad, fuerza resistencia de brazos y abdominales. Además se midieron niveles de actividad física en tiempo libre y/o uso de medios alternativos de transporte. El ejercicio fue prescrito de acuerdo con los estándares internacionales. Cada dos semanas se verificaron las actividades y los compromisos establecidos y se brindaron recomendaciones nutricionales. Resultados Se reportaron incrementos estadísticamente significativos del nivel de consumo de oxígeno (46,41±6,65 ml/Kg/min a 47,70±6,27 ml/Kg/min; p<0,01); incrementos en el nivel de fuerza resistencia en brazos (de 11,82±9,97 a 14,74 ±12,74 repeticiones; p<0,01) e incrementos en el número de abdominales (de 21,16 ±11,91 a 26,64±17,03 repeticiones; p<0,01). El cumplimiento real de los compromisos en la segunda medición fue de 2,54 ±2,07 días/semana de actividad física y de 144,16±238,89 minutos/semana en actividades adicionales de actividad física. Estos niveles fueron significativamente menores a los establecidos inicialmente de 4±1,05 días/semana y 239,52±73,01 minutos/semana (p<0,01). Conclusiones El programa de ejercicios prescritos no supervisados y la consejería, generaron incrementos en el consumo de oxígeno, la fuerza resistencia de brazos y el número de abdominales. El cumplimiento real de las actividades fue menor al compromiso inicial establecido.(AU)

Objectives Determining the effect of a prescribed unsupervised exercise and counseling program on the physical activity and fitness levels of university students volunteering for an emergency response brigade. Methodology Forty-two brigade volunteers engaged in a 12-week prescribed non-supervised exercise program. Body weight, body mass index (BMI), percentage body fat, waist circumference, oxygen consumption, flexibility and arms and abdomen strength endurance were assessed before and after performing the exercise program. The other variables measured concerned the level of physical activity during leisure time (days and minutes per week) and/or the use of alternative means of transport. Exercise was prescribed according to international standards. The activities, commitment and health-nutritional recommendations were controlled every two weeks. Results The study reported a statistically significant increase regarding the following variables: O2 consumption (from 46.41±6.65 ml/Kg/min to 47.70±6.27 ml/Kg/min; p<0.01), increased arm strength endurance (from 11.82±9.97 to 14.74±12.74 repetitions; p<0.01) and an increase in the number of abdominal exercises (crunches) (from 21.16±11.91 to 26.64±17.03 repeats; p<0.01). The real accomplishment regarding commitment by the time of the second measurement concerned 2.54±2.07 days/week and 144.16±238.89 minutes/week of physical activity. These levels were significantly lower than those established at the beginning of the program (4±1.05 days/week and 239.52±73.01 minutes/week; p<0.01). Conclusions The prescribed unsupervised exercise and counseling program led to increases in oxygen consumption, arm strength endurance and the number of repeat abdominal crunches. Real fulfilment of the proposed activities was lower than planned original commitment.(AU)

A prediction equation for the estimation of cardiorespiratory fitness using an elliptical motion trainer / Una ecuación de predicción para la evaluación de la capacidad cardiorespiratoria con un entrenador de movimiento elíptico

OBJECTIVE: In the United States of America, 6.2 million individuals are using elliptical motion trainers in fitness centres. However, graded exercise test protocols to estimate peak oxygen consumption (VO2peak) using elliptical motion trainers have not been developed for the general population. METHODS: Fifty-nine subjects (mean age: 23.5 ± 4.1 years) were randomly divided into a validation (VAL: n = 39) or cross-validation (XVAL: n = 20) group. Peak oxygen consumption (ml×kg-1×min-1) was measured via indirect calorimetry on an elliptical motion trainer for both groups. Subjects exercised at 150 strides×min-1 against a resistance of four and a crossramp of 8%. The resistance was increased every two minutes by two units until exhaustion. For the VAL group, a stepwise regression analysis was used to predict VO2peak from resistance, maximal heart rate (HRmax), body mass index (BMI), height and gender (female = 0, male = 1). RESULTS: The prediction equation derived from this study was VO2peak (ml·kg-1·min-1) = 187.39403 + 12.97271 (gender) - 1.45311 (height) - 1.21604 (BMI) - 0.19613 (HRmax) + 1.57093 (resistance) (R² = 0.76, SEE = 4.47, p < 0.05). Using this equation, the predicted VO2peak of the XVAL group was 45.18 ± 6.42 ml·kg-1×min-1, while the measured VO2peak was 43.55 ± 6.23 ml·kg-1×min-1 CONCLUSION: No significant difference was found between the measured and predicted VO2peak in the XVAL group. Therefore, it appears this protocol and equation will allow individuals to accurately estimate their VO2peak without using direct calorimetry. However, future studies should investigate the validity of this protocol with diverse populations.

OBJETIVO: En los Estados Unidos de América, 6.2 millones de personas están utilizando actualmente entrenadores de movimiento elíptico en los gimnasios. Sin embargo, no se han desarrollado protocolos de pruebas de ejercicios graduados para la población general, con el fin de calcular el consumo máximo de oxígeno (VO2máx) usando entrenadores elípticos. MÉTODOS: Cincuenta y nueve sujetos (edad media: 23.5 ± 4.1 años) fueron divididos aleatoriamente en un grupo de validación (VAL: n = 39) y un grupo de validación cruzada (XVAL: n = 20) respectivamente. El consumo de oxígeno máximo (ml×kg-1×min-1) se midió mediante calorimetría indirecta en un entrenador de movimiento elíptico para ambos grupos. Los sujetos ejercitaron 150 pasos por minuto frente a una resistencia de cuatro y una rampa cruz de 8%. La resistencia fue aumentada cada dos minutos en dos unidades hasta la extenuación. Para el grupo VAL, se utilizó un análisis de regresión paso a paso para predecir el VO2máx de la resistencia, la frecuencia cardíaca máxima (FCmáx), el índice de masa corporal (IMC), la altura y el género (mujer = 0, hombre = 1). RESULTADOS: La ecuación de predicción derivada de este estudio fue VO2máx (ml·kg-1 min-1) = 187.39403 + 12.97271 (sexo) - 1.45311 (altura) - 1.21604 (IMC) - 0.19613 (FCmáx) + 1.57093 (resistencia) [R2 = 0.76, SEE = 4.47, p < 0.05]. Usando esta ecuación, la predicción en VO2máx para el grupo XVAL fue 45.18 ± 6.42 ml·kg-1 min-1, mientras que la medición de VO2máx fue 43.55 ± 6.23 ml·kg-1×min-1. CONCLUSIÓN: No se hallaron diferencias significativas entre los valores de la medición y la predicción de VO2máx en el grupo XVAL. Por lo tanto, se evidencia que este protocolo y esta ecuación permitirán a las personas calcular con precisión su VO2máx sin utilizar calorimetría directa. Sin embargo, los estudios futuros deben investigar la validez de este protocolo con distintas poblaciones.

Avaliação da distância percorrida e velocidade média durante o TC6 em pacientes com diferentes doenças pulmonares / Six-minute walk distance and average speed evaluation in patients with differents lung diseases

Objetivo - Avaliar e comparar a distância percorrida pelos diferentes distúrbios pulmonares com a predita por Enright-Sherrill, assim como a velocidade média durante o teste de caminhada de seis minutos (TC6). Além de verificar se a idade, o índice de massa corporal (IMC), os índices espirométricos e a velocidade média poderiam influenciar na resposta do TC6. Métodos - Participaram 124 indivíduos com diagnóstico de doenças pulmonares, que foram divididos a partir da espirometria em três grupos: obstrutivo, restritivo e misto. Foram avaliados os dados antropométricos e pessoais destes, e depois encaminhados para realizar o TC6 segundo a ATS. Resultados - Observou-se diferença estatística (p<0,001) entre a distância percorrida pelos três grupos durante o TC6 com a predita por Enright-Sherrill. No entanto, quando avaliada a distância entre os grupos não foi observada diferença estatística (p>0,05). Em relação à velocidade média não houve diferença entre os grupos (p=0,666). Contudo, observou-se que esta variável é influenciada pelo tempo (p<0,001). Também se observou correlação entre a idade (r=-0,29) e a velocidade média (r=0,93) com a distância percorrida. Já a distância predita, apresentou correlação com o IMC (r=-0,84), idade (r=-0,36) e velocidade média (r=0,37). Conclusões - Quanto ao distúbioo pulmonar, não houve interferência deste sobre a distância percorrida e predita no TC6, e sobre a velocidade média. No entanto, observou-se que a idade, o IMC e a velocidade média são os responsáveis pela resposta do TC6.

Objective -To evaluate and compare the six-minute walking distance (6MWD) in different lung disorders with the predicted by Enright-Sherrill; as well as the average speed during the six-minute walk test (6MWT). Beyond this, check if age, body-mass index, lung function and average speed can influence the response of 6MWT. Methods - This study included 124 subjects with lung diseases, which have been divided from the lung functions results in three groups: obstructive, restrictive and mixed. The anthropometrics and personal data was evaluated, and then, they were sent to perform the 6MWT, according to ATS. Results - We observed statistical difference (p<0.001) between the 6MWD obtained by the groups and the predicted by Enright-Sherrill. However, we didn't observed statistical difference among the groups, when we evaluate the 6MWD. In relation to average speed, we didn't find difference among groups (p=0.666). However, we observed that the time influenced this variable (p<0.001). Also, we observed correlation between the age (r=-0.29) and average speed (r=0.93) with the 6MWD. Already, the predicted 6MWD had correlation with body-mass index (r=-0.84), age (r=-0.36) and average speed (r=0.37). Conclusions - As to lung disorders, there was no interference about six-minute walk distance and predicted 6MWD, as well as about average speed. However, has been observed that age, body-mass index and average speed are the responsible for the response of 6MWT.

Protocolo de esforço durante a corrida em piscina funda / Effort protocol during a deep-pool swimming race

Tanto a frequência cardíaca, quanto a percepção subjetiva de esforço, aumentaram linearmente em relação ao incremento das cadências durante o exercício de corrida em piscina funda

Polar S810 como recurso alternativo ao eletrocardiograma no teste de exercício de 4 segundos / Polar S810 as an alternative resource to the use of the electrocardiogram in the 4-second exercise test

FUNDAMENTO: O teste de exercício de 4 segundos (T4s) avalia o tônus vagal cardíaco durante o transiente inicial da frequência cardíaca (FC), em exercício dinâmico súbito, por meio da identificação do índice vagal cardíaco (IVC) obtido a partir do eletrocardiograma (ECG). OBJETIVO: Testar a utilização do monitor de frequência cardíaca (MFC) Polar S810 como recurso alternativo ao ECG na aplicação do T4s. MÉTODOS: Neste trabalho, 49 indivíduos do sexo masculino (25 ± 20 anos, 176 ± 12 cm, 74 ± 6 kg) realizaram o T4s. Os intervalos RR foram registrados simultaneamente por ECG e MFC. Calcularam-se média e desvio padrão do último intervalo RR do período pré-exercício ou o primeiro do período de exercício, aquele que for mais longo (RRB), do mais curto intervalo RR do período de exercício (RRC) e do IVC obtidos por ECG e MFC. Utilizou-se o teste t de Student para amostras dependentes (p < 0,05) para testar a significância das diferenças entre as médias. Para identificar a concordância entre o ECG e o MFC, utilizou-se a regressão linear, com cálculo do coeficiente de correlação de Pearson e a estratégia proposta por Bland e Altman. RESULTADOS: A regressão linear apresentou r² de 0,9999 para o RRB, 0,9997 para o RRC e 0,9996 para o IVC. A estratégia de Bland e Altman apresentou desvio padrão de 0,92 ms para o RRB, 0,86 ms para o RRC e 0,002 para o IVC. CONCLUSÃO: O MFC Polar S810 se mostrou eficiente na aplicação do T4s quando comparado ao ECG.

BACKGROUND: The 4-second exercise test (T4s) evaluates the cardiac vagal tone during the initial heart rate (HR) transient at sudden dynamic exercise, through the identification of the cardiac vagal index (CVI) obtained from the electrocardiogram (ECG). OBJECTIVE: To evaluate the use of the Polar S810 heart rate monitor (HRM) as an alternative resource to the use of the electrocardiogram in the 4-second exercise test. METHODS: In this study, 49 male individuals (25 ± 20 years, 176 ±12 cm, 74 ± 6 kg) underwent the 4-second exercise test. The RR intervals were recorded simultaneously by ECG and HRM. We calculated the mean and the standard deviation of the last RR interval of the pre-exercise period, or of the first RR interval of the exercise period, whichever was longer (RRB), of the shortest RR interval of the exercise period (RRC), and of the CVI obtained by ECG and HRM. We used the Student t-test for dependent samples (p < 0.05) to test the significance of the differences between means. To identify the correlation between the ECG and the HRM, we used the linear regression to calculate the Pearson's correlation coefficient and the strategy proposed by Bland and Altman. RESULTS: Linear regression showed r² of 0.9999 for RRB, 0.9997 for RRC, and 0.9996 for CVI. Bland e Altman strategy presented standard deviation of 0.92 ms for RRB, 0.86 ms for RRC, and 0.002 for CVI. CONCLUSION: Polar S810 HRM was more efficient in the application of T4s compared to the ECG.

Validação de um protocolo para o teste de caminhada de seis minutos em esteira para avaliação de pacientes com hipertensão arterial pulmonar / Validation of a treadmill six-minute walk test protocol for the evaluation of patients with pulmonary arterial hypertension

OBJETIVO: Elaborar e validar um protocolo para teste de caminhada de seis minutos em esteira (TC6est) para a avaliação de pacientes com hipertensão arterial pulmonar (HAP). MÉTODOS: A população do estudo foi composta por 73 pacientes com HAP diagnosticados através de cateterismo cardíaco direito, com ou sem inalação de NO. Todos os pacientes realizaram um TC6 em solo e três TC6est baseados em um protocolo de incremento de velocidade pré-determinado e intercalados por um período de repouso. Os pacientes que haviam realizado o teste hemodinâmico com inalação de NO realizaram o terceiro TC6est com a inalação da mesma dose de NO utilizada durante o cateterismo. RESULTADOS: Os resultados mostraram uma correlação da distância caminhada no TC6est com os dados hemodinâmicos, assim como com a classe funcional e com a distância caminhada no solo. Além disso, a distância percorrida no TC6est apresentou uma correlação significativa com a sobrevida, confirmando, portanto, sua correlação com a gravidade da doença. A inalação de NO durante o TC6est levou a variações compatíveis com as variações hemodinâmicas frente à mesma dose de NO, sugerindo que o protocolo em questão pode refletir o efeito de intervenções terapêuticas. CONCLUSÕES: Concluímos que a distância percorrida no TC6est é um marcador funcional e prognóstico na avaliação de rotina de pacientes com HAP.

OBJECTIVE: To develop and validate a protocol for the treadmill six-minute walk test (tread6MWT) to evaluate patients with pulmonary arterial hypertension (PAH). METHODS:The study population comprised 73 patients with PAH, diagnosed by means of right heart catheterization, with or without NO inhalation. All patients performed a hallway 6MWT and three tread6MWTs based on a pre-determined incremental speed protocol and interposed by a rest period. The patients who had been submitted to hemodynamic testing using NO performed the third tread6MWT while inhaling the same dose of NO that had been used during the catheterization. RESULTS: We found that the treadmill six-minute walk distance (tread6MWD) correlated with hemodynamic data, functional class and the hallway six-minute walk distance (6MWD). In addition, the tread6MWD correlated significantly with survival, thereby confirming the correlation with disease severity. Inhalation of NO during the tread6MWT led to variations that were consistent with the hemodynamic changes induced by the same dose of inhaled NO, suggesting that the protocol developed can reflect the effect of therapeutic interventions. CONCLUSIONS: We conclude that the tread6MWD is a useful prognostic and functional marker for the routine evaluation of PAH patients.