Effect of Physical Training on Nitric Oxide Levels in Patients with Arterial Hypertension: An Integrative Review

Abstract The regular practice of physical exercise as a non-pharmacological treatment of arterial hypertension (AH) has been encouraged due to causing a series of physiological responses in the cardiovascular system, such as the production of vasoactive substances, including nitric oxide (NO). NO is a relaxation factor released by the endothelium, and the decrease in its bioavailability is related to coronary and arterial diseases, such as AH. This study aimed to perform an integrative literature review to elucidate the effect of physical training on NO levels in patients with AH and to establish a relationship between these levels and blood pressure (BP) control. A literature review was was performed by searching PubMed / MEDLINE, Lilacs, Scielo, Cinahl and Embase databases. The search string used was ("arterial hypertension" OR hypertension) AND (exercise OR "physical exercise" OR "aerobic exercise" OR "exercise training" or "physical activity") AND ("nitric oxide"). We included fully available controlled and uncontrolled clinical trials published in English and Portuguese languages in the last 10 years. The review consisted of 16 articles, of which 13 reported an increase in NO production after the physical training intervention, and three studies found no change. In addition, 15 studies observed a reduction in BP after the intervention. In conclusion, regular practice of physical exercises, advocating moderate intensity, can improve NO bioavailability in pre-hypertensive and hypertensive individuals, which seems to be one of the mechanisms responsible for BP reduction.

Physical training in athletes: analysis of cardiac autonomic modulation / Treinamento físico em esportistas: análise da modulação autonômica cardíaca / Entrenamiento físico en deportistas: análisis de la modulación autonómica cardíaca

ABSTRACT Introduction Cardiac autonomic modulation (CAM) is a result of the balance between the sympathetic and parasympathetic systems. This interaction results in heart rate variation (HRV), analyzed by specific electrocardiographic parameters. These parameters are modified by the practice of physical activity, indicating better cardiac conditioning. Objectives To evaluate the cardiac autonomic modulation of athletes of the XXVIII Ecological Walk at two separate times during their period of physical training. Also, to link the practice of physical activity with stress reduction in these individuals. Methods 24-hour Holter exams were performed at two times (before and after a 2-month period of non-standard physical training), and the results were analyzed using the software programs Epi-Info 7 and BioEstat 5.0. Inferential analysis was performed by the nonparametric Shapiro-Wilk test. Statistical significance was assigned to p values less than 0.05, with 95% confidence interval (95% CI). Results The sample was mostly male (n = 14; 77.78%), with a mean age of 49.55 years. No individual trained for less than 60 days; most (47.06%) trained for 151-200 days, with walking being the predominant modality (64.71%). No statistically significant difference was found in the parameters HRV pNN50 (p = 0.18), rMSSD (p = 0.14) or HF (p = 0.117) after the evaluated training period. Conclusions Participants who are longtime sportsmen and physically active showed parasympathetic saturation, therefore, they did not show significant changes in HRV. Also, low levels of stress were observed in those who practiced physical activity. Level of evidence II; Prognosis Study.

RESUMO Introdução A modulação autonômica cardíaca (MO) é resultado do equilíbrio entre os sistemas simpático e parassimpático. Essa interação resulta na variação da frequência cardíaca (VFC) analisada por parâmetros eletrocardiográficos específicos, que são modificados pela prática de atividade física, indicando melhor condicionamento cardíaco. Objetivos Analisar a modulação autonômica cardíaca em esportistas da XXVIII Caminhada Ecológica em dois momentos durante seu período de treinamento físico. Além disso, relacionar a prática de atividade física com a redução do estresse nesses indivíduos. Métodos Foram realizados exames de Holter de 24 horas em dois momentos (antes e depois de um período de dois meses de treinamento físico não padronizado), sendo os resultados analisados por meio dos programas Epi-Info 7 e BioEstat 5.0. A análise inferencial foi feita pelo teste não paramétrico de Shapiro-Wilk. A significância estatística foi atribuída aos valores de p menores que 0,05 e intervalo de confiança de 95% (IC 95%). Resultados A amostra era majoritariamente masculina (n = 14; 77,78%), com média de idade de 49,55 anos. Nenhum indivíduo treinou por menos de 60 dias, a maioria (47,06%) treinou por 151 a 200 dias, sendo a caminhada a modalidade predominante (64,71%). Não foi encontrada diferença estatisticamente significativa nos parâmetros de VFC pNN50 (p = 0,18), rMSSD (p = 0,14) e HF (p = 0,117) depois do período de treinamento avaliado. Conclusão Os participantes que são esportistas de longa data e fisicamente ativos apresentaram saturação parassimpática, por isso não evidenciaram alterações significativas na VFC. Além disso, observou-se menor nível de estresse nos praticantes de atividade física. Nível de evidência II; Estudo prognóstico.

RESUMEN Introducción La modulación autonómica cardíaca (MO) es el resultado del equilibrio entre los sistemas simpático y parasimpático. Esta interacción resulta en la variación de la frecuencia cardíaca (VFC), analizada por parámetros electrocardiográficos específicos, que son modificados por la práctica de actividad física, indicando mejor acondicionamiento cardíaco. Objetivos Analizar la modulación autonómica cardíaca en deportistas de la XXVIII Caminata Ecológica en dos momentos durante su período de entrenamiento físico. Además, relacionar la práctica de actividad física con la reducción del estrés en estos individuos. Métodos Fueron realizados exámenes Holter de 24 horas en dos momentos (antes y después de un período de dos meses de entrenamiento físico no estandarizado), siendo los resultados analizados por medio de los programas Epi-Info 7 y BioEstat 5.0. El análisis inferencial se realizó mediante el test no paramétrico de Shapiro-Wilk. La significancia estadística fue atribuida a los valores de p inferiores a 0,05 e intervalo de confianza del 95% (IC 95%). Resultados La muestra era mayoritariamente masculina (n = 14; 77,78%), con un promedio de edad de 49,55 años. Ningún individuo entrenó durante menos de 60 días, la mayoría (47,06%) entrenó durante 151-200 días, siendo la caminata la modalidad predominante (64,71%). No fue encontrada diferencia estadísticamente significativa en los parámetros de VFC pNN50 (p = 0,18), rMSSD (p = 0,14) y HF (p = 0,117) después del período de entrenamiento evaluado. Conclusión Los participantes que son deportistas de larga data y físicamente activos presentaron saturación parasimpática, por eso no evidenciaron alteraciones significativas en la VFC. Además, se observó un menor nivel de estrés en los practicantes de actividad física. Nivel de evidencia II; Estudio pronóstico.

Impacto de la pandemia por covid-19 en los deportistas / Impact of the covid-19 pandemic on athletes

La pandemia del covid-19 afectó a todo el planeta, alterando la salud, la libertad, la economía, la cultura y la seguridad. El mundo del deporte no quedó al margen de esta situación. Los deportistas debieron confinarse como el resto de la población, pero esto implicó para ellos un desentrenamiento prolongado (más de cuatro semanas) que provocó la pérdida de muchas de las adaptaciones físicas y psicológicas que genera el entrenamiento. Se generaron alteraciones en los sistemas cardiorrespiratorio, inmune y osteomuscular y endócrino, en el metabolismo, y un aumento de masa grasa en detrimento de la masa magra, lo que puede generar lesiones en el regreso a la actividad. Se tomaron medidas paliativas para que el desentrenamiento no fuera tan profundo, pero, como su nombre lo indica, estas medidas no reemplazan totalmente el entrenamiento. (AU)

The covid-19 pandemic has been affecting the worldwide, not only in relation to the health but also to the liberty, the economy, the culture and the security. However, sports have not been the exception. The athletes fell into confinement as the rest of the population, but these led to a prolonged detraining, (more than four weeks), which caused the loss of all physical and psychological adaptation generated by training. Some alterations were observed in the cardiorespiratory system, in the immunity, in the osteo-muscular apparatus, in the metabolic system, in the endocrine system and in the increase in fat mass at the expense of lean mass, which can cause injuries during the return to activity. Palliative measures were taken so that detraining wasn't so deep, but as the name implies, this measures do not totally replace training. (AU)

Hemoglobina glicada y ejercicio: una revisión sistemática / Effects of physical training in patients with type 2 diabetes mellitus: a systematic review

Physical training is recommended in several studies and guidelines for the control of type 2 diabetes mellitus (DM2) and its complications. We performed a systematic review about the effects of aerobic training (AT), resistance (RT) or the combination of both (AT/ RT), on glycated hemoglobin (HbA1c) in patients with DM2. Therefore, we included 15 clinical trials with at least 12 weeks duration about training program or recommendations of physical exercise, that evaluated the reduction in HbA1c levels in patients with DM2. Information was obtained on training modality (AT, RT or AT / RT), training parameters, duration and weekly training frequency. The results showed increases in peak or maximal oxygen uptake, exercise tolerance time and muscle strength, depending on the type of training, and a reduction in HbA1c levels. We conclude that exercise training is associated with reductions of HbA1c in patients with DM2. Thus, it can be a complementary tool in the management of these patients.

Improvement in muscular strength and aerobic capacities in elderly people occurs independently of physical training type or exercise model

OBJECTIVES: Progressive decline of physiological processes with aging is normal. Aging is also associated with decreased functional capacity and onset of many diseases. This study evaluated the changes in physical fitness (PF), body composition (BC), and lipid profile (LP) in elderly men completing different training protocols. METHODS: Fifty-five men (age 60-80 years) were randomized into the following groups: without training, aerobic training on dry land, combined training on dry land, and combined training in water. Training was conducted for 8 weeks, and PF, LP, and BC were assessed at the beginning and end of the intervention. RESULTS: Significant improvements were observed in all parameters; however, combined programs on land or in water were more effective at improving strength and aerobic fitness. Combined exercise produced greater effects on BC and LP and some muscle fitness parameters; however, improvements in muscular and aerobic capacities occurred independently of exercise type or model. CONCLUSION: These results indicate that the effects of training occur regardless of training type or model, and are directly associated with training periodization, adherence, and regularity.

Perfiles de riesgo cardiovascular y condición física en docentes y empleados no docentes de una facultad de salud / Cardiovascular risk profile and fitness in professors and employees of a faculty of health

RESUMEN Objetivo Establecer el perfil de riesgo cardiovascular y la condición física de docentes y empleados no docentes en una facultad de salud de una universidad pública. Materiales y Métodos Estudio observacional transversal con 40 docentes y 13 empleados, se realizó: test de caminata, Cuestionario Internacional de Actividad Física (IPAQ), Auto informe de Barreras para la Práctica de Ejercicio Físico, antropometría, perfil lipídico, hemoglobina glicosilada y se identificó el riesgo cardiovascular con la Escala Framingham Clásica. Resultados El 51,4 % de los docentes y 41,7 % de los no docentes presentaron bajo riesgo cardiovascular. Para ambos el valor promedio del IMC fue 25,56 Kg/cm2±3,9 Kg/cm2 y 23,18 Kg/cm2 ± 3,7 Kg/cm2 respectivamente. El promedio del peso graso de los docentes fue del 32 % y en no docentes 27 %. La distancia promedio recorrida por los docentes fue 553 ± 226 metros y para los no docentes de 590 ± 187 metros. Ambos grupos presentaron buena flexibilidad. El 49 % de docentes y el 77 % de los no docentes presentaron nivel de actividad física alto según el IPAQ. Las principales barreras para la práctica del ejercicio físico fueron la falta de tiempo y el exceso de obligaciones. Conclusiones Los empleados docentes y no docentes de la facultad de salud presentaron bajo riesgo cardiovascular con alto nivel de actividad física, esto debe ser considerado en la implementación de programas de promoción de estilos de vida saludable y prevención de enfermedad cardiovascular.(AU)

ABSTRACT Objective To establish the cardiovascular risk profile and fitness of professors and employees of a faculty of health within a public university. Materials and Methods Cross-sectional study with 40 professors and 13 employees who were tested using anthropometry, lipid profile, glycosylated hemoglobin, a 6 minute walking test; two questionnaires on physical activity and barriers to exercise were applied. The cardiovascular risk was calculated for all subjects using the Framingham scale. Results 51.4 % of professors and 41.7 % of employees had low cardiovascular risk. The average value of BMI for teachers and employees showed low cardiovascular risk; the average BMI value was 25,56 Kg/cm2 ± 3,9 Kg/cm2 and 23,18 Kg/cm2 ± 3,7 Kg/cm2, respectively. The average fat mass was 32 % for professors and 27 % for employees. The average distance walked by professors was 553 ± 226 meters and for employees was 590 ± 187 meters. Both groups showed good flexibility; 49 % of teachers and 77 % of employees had a high level of physical activity according to their IPAQ. The main barriers to physical exercise were lack of time and extra obligations. Conclusions Professors and employees of the faculty of health had low cardiovascular risk and high physical activity; this should be considered in the implementation of programs promoting healthy lifestyles and prevention of cardiovascular diseases.(AU)

Low intensity static stretching does not modulate heart rate variability in trained men / Alongamento estático de baixa intensidade não modula a variabilidade da frequência cardíaca em homens treinados

OBJECTIVE: To investigate the acute effect of static stretching on heart rate variability in trained men. METHODS: Eight subjects were randomly submitted to two situations, as follows: a static stretch protocol and 20 minutes at rest. The stretch protocol consisted of two sets of 30 seconds of static stretch of the chest muscles with a 40 second of interval between them. After 48 hours, the procedures were reversed so that all the subjects should were submitted to the two situations. The values of heart rate variability were measured before and after the experimental and control situation (stretch vs. rest). We registered the following cardiac variables: root mean square of standard deviation (rMSSD), the number of pairs of successive beats that differ by more than 50 ms (pNN50), low frequency (LF) and high frequency (HF). The Shapiro-Wilk and the paired Student's test were used for statistical analysis; a critical level of significance of p < 0.05 was adopted. RESULTS: No significant differences (p > 0.05) were found (stretching vs. control) to the RMSSD, pNN50, LF and HF indices. However, although no statistical differences were observed, the figures show large changes on mean values, suggesting an unclear effect on the sympathetic-vagal modulation. CONCLUSION: The present results suggest that a low intensity (motion range until discomfort point) and volume (1 minute) of static stretching does not significantly affect the acute sympathetic-vagal control in trained men. Because the protocol did not show differences regarding the studied variables, we suggest that there is not a sufficient level of physiological basis to perform this type of exercise in a traditional pre-exercise setting, if the purpose is obtain gains in physical performance.

OBJETIVO: Nosso objetivo foi verificar o efeito agudo do alongamento estático sobre a variabilidade da frequência cardíaca (VFC) em homens treinados. MÉTODOS: Oito voluntários (n = 8) foram randomicamente submetidos a duas situações, a saber: alongamento estático (AE) ou 20 minutos em repouso (CTRL). O protocolo de alongamento consistiu em duas séries de 30 segundos para musculatura do peitoral (40 segundos de intervalo). Após 48 horas, os procedimentos foram realizados de maneira reversa, de forma que todos os participantes realizaram as duas situações (ALONGAMENTO e CRTL) ao final do estudo. Os valores de VFC foram medidos antes e imediatamente depois das situações experimental e controle (alongamento vs. repouso). Para registro das variáveis cardíacas coletadas (rMSSD, pNN50, LF e HF) no presente estudo, nós utilizamos um relógio Polar RS800CX (Polar Electro OY, Finland). As análises estatísticas realizadas foram feitas através da aplicação do teste de Shapiro-Wilk seguido pelo teste t de Student pareado, sendo adotado um nível crítico de significância de p < 0.05. RESULTADOS: Nenhuma diferença significativa (p > 0.05) foi observada (alongamento vs. controle) quando as variáveis foram analisadas. CONCLUSÃO: O presente estudo sugere que o alongamento estático com baixo volume de aplicação não altera significativamente o controle simpato-vagal em homens treinados. Na medida em que o protocolo utilizado não resultou em diferenças significativas nas variáveis estudadas, nós inferimos que não há fundamento fisiologicamente válido para a realização deste tipo de exercício em sua forma tradicional pré-exercício quando o objetivo for a obtenção de ganhos na performance física.

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)

Factores orgánicos de la capacidad física en la edad infantil: alometría y fractalidad en la fundamentación fisiológica de la capacidad física / Organic factors of physical capacity in childhood: allometry and fractality in the physiological basis of physical capacity

From a biological point of view, the physical capacity may be explained to some extent in terms of its organic elements. In the childhood, when the organism has not grow completely mature, the lower physical capacity can be understand as emerged from the low dimension of the different functional areas compared to that of the adult. Nevertheless, this "fractal" conception of the organic factors of the physical capacities needs to be changed for an "alometric" scheme, since the biological systems are not "fractal" but "alometric" this signifying that summoning up all of them, it cannot be obtained a proportional sum formed by their all. Wrapping all of that up, it can be said that the consideration of the organic elements related with the physical capacity should be done as an integration that realizes the way in which they interact to determine the capacity of the organism to move.

Factores predictivos de las infecciones posoperatorias / Prediction factors of the postoperative infections

Introducción: la génesis de las infecciones posquirúrgicas es multifactorial. Existen estudios internacionales que evidencian los diversos factores predictivos relacionados con la aparición de estas complicaciones, las que todavía afectan a un número considerable de pacientes intervenidos, todo lo cual justifica el interés en la realización de este trabajo. Objetivo: describir el comportamiento de algunos de los factores predictivos relacionados con la aparición de las infecciones posoperatorias en nuestro medio. Métodos: se realizó un estudio observacional, descriptivo y transversal de los pacientes ingresados y operados que presentaron infecciones posquirúrgicas en el servicio de cirugía general del Hospital Provincial Docente Saturnino Lora de Santiago de Cuba, durante el año 2008, según posibles factores predictivos seleccionados. Resultados: con relación al grado de contaminación, la tasa global de infección posoperatoria y la de heridas limpias estuvo en límites universalmente aceptados, aunque fueron más elevadas en las intervenciones urgentes, sucias y contaminadas para las localizadas en el sitio quirúrgico, así como en enfermos con estado físico preoperatorio según la American Society of Anaesthesiology (ASA) ASA II Y ASA III, con independencia de su estado nutricional y el tiempo quirúrgico en que se efectuaron las intervenciones. Conclusiones: las tasas de infecciones posquirúrgicas aumentaron en la medida en que fueron desfavorables las condiciones bajo las que se efectuaron las operaciones, y los factores predictivos seleccionados se relacionaron principalmente para las localizadas en el sitio quirúrgico, con el grado de contaminación, el tipo de intervención y el estado físico preoperatorio del paciente(AU)

Introduction: the genesis of the postsurgical infections is multifactor. The are many international studies evidencing the different prediction factors related to the appearance of these complications, which still involve a significant number of patients operated on, thus justifying the interest in the conduction of present paper. Objective: to describe the behavior the some of the prediction factors related to appearance of the postoperative infections in our practice. Methods: a cross-sectional, descriptive and observational study was conducted in admitted and operated on patients with postsurgical infections in the general surgery service of the Saturnino Lora Teaching Provincial Hospital over 2008, according to the selected prediction factors. Results: in relation to the contamination, the global rate of postoperative infection and that of the clean wounds are within the universally accepted limits, although are higher in the urgent, dirty and contaminated interventions for that located in the surgical site, as well as in patients with an ASA II and ASA III physical condition according the American Society of Anaesthesiology (ASA) independently of its nutritional status and the surgical time of interventions. Conclusions: the postsurgical infection rates increase as far as the conditions to operate on are unfavourable and the selected prediction factors are related mainly to that located in the surgical site, with de contamination level, the type of intervention and the physical preoperative status of patient(AU)

Impacto del tabaquismo en el rendimiento físico. Resultados de la IV Carrera contra el Tabaco / Impact of tobacco smoking on physical performance. Results froma the fourth race against tobacco

Introducción: Se ha demostrado que la participación en actividades deportivas promueve la salud física y mental. En contraste, la conducta de fumar (y la eventual adicción al tabaco) entre los estudiantes correlaciona inversamente con la práctica regular de actividades deportivas. A pesar de las reglamentaciones y de la evidencia científica en su contra, la industria tabacalera no ha dudado en vincular la conducta de fumar con el hábito del deporte. Hipótesis: El rendimiento de los atletas puede estar disminuido por efectos del tabaquismo. Una segunda hipótesis sostiene que la industria tabacalera influye en un número importante de atletas, induciéndolos a fumar. Para probarlas, analizamos el desempeño de los 680 corredores que participaron en la IV Carrera contra el Tabaco. Resultados: No se encontraron diferencias significativas entre los sexos, ni entre los grupos determinados por las edades. De acuerdo al análisis de varianza, las diferencias por tiempo entre los grupos fueron significativas. El tiempo promedio que invirtieron todos los participantes en recorrer cada kilómetro fue de 5.09 ? 1.02min. El tiempo de los no fumadores (5.02 min/km) fue significativamente menor que el de los ex fumadores (5.15min/km), y de los fumadores (5.75min/km). Conclusiones: El rendimiento físico de los que nunca han fumado es significativamente mejor de aquellos que sí fuman. Además, entre los individuos que practican de manera regular un deporte, hay un porcentaje importante de fumadores. Por lo tanto, entre los individuos que hacen ejercicio se debe hacer promoción antitabaco.