Exercise Training Improved Pulmonary Gas Exchange Abnormalities in Pulmonary Hypertension due to Heart Failure: A Case Report

Abstract Heart failure (HF) is the most common cause of pulmonary hypertension (PH), and reduced exercise capacity and exertional dyspnea are the most frequent concerns in patients with PH-HF. Indeed, carbon dioxide end-tidal partial pressure (PETCO 2 ) during exercise is a well-established noninvasive marker of ventilation/perfusion ratio in PH. We aimed to evaluate the effect of aerobic exercise training on PETCO 2 response during exercise in a 59-year-old woman with PH secondary to idiopathic dilated cardiomyopathy. The patient with chronic fatigue and dyspnea at mild-to-moderate efforts was admitted to a cardiorespiratory rehabilitation program and had her cardiorespiratory response to exercise assessed during a cardiopulmonary exercise testing performed before and after three months of a thrice-weekly aerobic exercise training program. Improvements in aerobic capacity (23.9%) and endurance time (37.5%) and reduction in ventilatory inefficiency (-20.2%) was found after intervention. Post-intervention improvements in PETCO 2 at ventilatory anaerobic threshold (23.3%) and change in PETCO 2 kinetics pattern, with progressive increases from rest to peak of exercise, were also found. Patient also improved breathing pattern and timing of ventilation. This case report demonstrated for the first time that aerobic exercise training might be able to improve PETCO 2 response during exercise in a patient with PH-HF.

Effects of heated water-based exercise on blood pressure: a systematic review / Efeito do exercício em piscina aquecida sobre a pressão arterial: uma revisão sistemática / Efecto del ejercicio en piscina climatizada sobre la presión arterial: una revisión sistemática

Abstract Introduction: Systemic arterial hypertension is one of the main cardiovascular risk factors affecting several population. In this context, heated water-based exercise has emerged as a potential alternative to land- based physical exercise to reduce blood pressure (BP) in hypertensive patients. Objective: To systematically synthesize evidence for the lowering effects of heated water-based exercise on BP in a non-specific population. Methods: Scielo, Pubmed and Scopus electronic databases were searched for studies from 2005 to 2016, with the following descriptors in English: "blood pressure, exercise, immersion, blood pressure and hydrotherapy". A total of 10,461 articles were found and, after applying the inclusion and exclusion criteria, 13 articles were selected and included in the final analysis. All included articles evaluated individuals from different populations and age groups, submitted to a heated water-based exercise session and/or program. Results: The results suggest that both an acute single session and chronic training period (12 to 24 weeks) of heated water-based exercise may reduce BP in different populations (normotensive, hypertensive, postmenopausal women, and heart transplant populations). The magnitude and duration of acute and chronic hypotensive effect of exercise ranged substantially, which was probably due to the variety of exercise frequency, duration and intensity, as well as due to the studied population. Conclusion: These results suggest that heated water-based exercise may promote acute and chronic hypotensive effects in different populations. However, there is no homogeneity in the protocols used, which may have led to the heterogeneity in magnitude and duration of BP reductions.

Resumo Introdução: A hipertensão arterial sistêmica (HAS) é um dos principais fatores de risco cardiovasculares que afeta diferentes populações. Sendo assim, o exercício físico em piscina aquecida tem surgido como uma potencial alternativa ao exercício físico em solo para a redução da pressão arterial (PA) de indivíduos hipertensos. Objetivo: Revisar a evidência dos efeitos do exercício físico em piscina aquecida na redução da PA em populações não especificas. Métodos: Foram pesquisadas as bases de dados eletrônicas Scielo, Pubmed e Scopus, de 2005 a 2016, com os seguintes descritores em inglês: "pressão arterial, exercício, imersão, pressão arterial e hidroterapia". Foram encontrados 10.461 artigos e, após a aplicação dos critérios de inclusão e exclusão, foram selecionados 13 artigos que fizeram parte da análise final. Todos os artigos incluídos avaliaram indivíduos de diferentes populações, em diferentes faixas etárias, submetidos a uma sessão e/ou programa de exercícios físicos em piscina aquecida. Resultados: Os resultados sugerem que uma sessão aguda de exercício físico em piscina aquecida, bem como um programa de treinamento de 12 a 24 semanas, pode reduzir a pressão arterial em diferentes populações (normotensos, hipertensos, mulheres na pós-menopausa e transplantados cardíacos). Houve uma grande variação na magnitude e duração do efeito hipotensivo do exercício, o que pode ter sido devido à grande variação de frequência, duração e intensidade das sessões, bem como de populações estudadas. Conclusão: Estes resultados sugerem que o exercício físico em piscina aquecida pode ter efeito hipotensivo agudo e crônico em diferentes populações. No entanto, não há homogeneidade nos protocolos utilizados, o que pode ter levado à heterogeneidade na magnitude e duração das reduções de PA.

Resumen Introducción: La hipertensión arterial sistémica es uno de los principales factores de riesgo cardiovascular que afecta diferentes poblaciones. Siendo así, el ejercicio físico en piscina calentada ha surgido como una alternativa potencial al ejercicio físico en suelo para la reducción de la presión arterial (PA) de pacientes hipertensos. Objetivo: Revisar la evidencia de los efectos del ejercicio físico en la piscina calentada en la reducción de la PA en poblaciones no específicas. Métodos: Buscamos las bases de datos electrónicas Scielo, Pubmed y Scopus, de 2005 a 2016, con los siguientes descriptores en inglés: "presión arterial, ejercicio, inmersión, presión arterial e hidroterapia". Se encontraron 10461 artículos y, después de la aplicación de los criterios de inclusión y exclusión, fueron seleccionados 13 artículos que fueron parte del análisis final. Todos los artículos incluidos evaluaron individuos de diferentes poblaciones en diferentes grupos de edad sometidos a programas de ejercicios físicos acuáticos. Resultados: Los resultados sugieren que el ejercicio físico realizado en una piscina calentada puede llevar a diferentes respuestas en la presión arterial, dependiendo de la frecuencia, la duración y la intensidad de las sesiones. Conclusión: Estos resultados sugieren que el ejercicio realizado en una piscina calentada durante 12 a 24 semanas de entrenamiento puede promover efectos benéficos sobre la reducción de la PA. Por otra parte, la sesión aguda no es suficiente para causar un efecto hipotensor. Sin embargo, no hay homogeneidad en los protocolos utilizados, lo que puede haber llevado la divergencia en los resultados.

Effects of Motor Learning on Clinical Isokinetic Test Performance in Knee Osteoarthritis Patients

OBJECTIVES: To analyze the effects of motor learning on knee extension-flexion isokinetic performance in knee osteoarthritis patients. METHODS: One hundred and thirty-six middle-aged and older sedentary individuals (111 women, 64.3±9.9 years) with knee osteoarthritis (130 patients with bilateral) and who had never performed isokinetic testing underwent two bilateral knee extension-flexion (concentric-concentric) isokinetic evaluations (5 repetitions) at 60°/sec. The tests were first performed on the dominant leg with 2 min of recovery between test, and following a standardized warm-up that included 3 submaximal isokinetic repetitions. The same procedure was repeated on the non-dominant leg. The peak torque, peak torque adjusted for the body weight, total work, coefficient of variation and agonist/antagonist ratio were compared between tests. RESULTS: Patients showed significant improvements in test 2 compared to test 1, including higher levels of peak torque, peak torque adjusted for body weight and total work, as well as lower coefficients of variation. The agonist/antagonist relationship did not significantly change between tests. No significant differences were found between the right and left legs for all variables. CONCLUSION: The results suggest that performing two tests with a short recovery (2 min) between them could be used to reduce motor learning effects on clinical isokinetic testing of the knee joint in knee osteoarthritis patients.

Serum 25-hydroxyvitamin D levels are associated with functional capacity but not with postural balance in osteoporotic postmenopausal women

OBJECTIVES: In post-menopausal women with osteoporosis, insufficient vitamin D levels decrease calcium fixation in the bones and calcium transport in the sarcoplasmic reticulum, which impairs muscle strength, possibly leading to detrimental consequences for the preservation of functional capacity and postural balance, fall prevention, and fracture risk. The aim of this study was to evaluate the association between vitamin D levels and knee muscle strength, postural balance and functional mobility among postmenopausal women with osteoporosis. METHODS: This cross-sectional study included 63 osteoporotic older women (aged 60.6±3.1 years). The subjects completed the Timed Up and Go Test to measure functional mobility, and postural balance was assessed on the AccuSway Plus portable force platform. Maximal strength was tested using an isokinetic dynamometer for knee flexion and extension. The subjects were assessed as a group and were divided into quartiles according to their vitamin D levels. Clinicaltrials.gov: NCT02771834. RESULTS: Vitamin D status was independently associated with the normalized peak torque of the knee extensors (β=0.59; p=0.04) and Timed Up and Go Test (β=-0.07; p<0.001). No between-group differences were observed in the demographic and clinical variables or postural balance; however, significant differences were observed in the Timed Up and Go Test, and the group with the highest vitamin D levels exhibited better performance than the group with the lowest vitamin D levels (p<0.001). CONCLUSION: The serum vitamin D levels were independently associated with normalized knee extension strength and functional mobility in postmenopausal women with osteoporosis.

Effects of resistance training in older women with knee osteoarthritis and total knee arthroplasty

OBJECTIVES: This study sought to analyze the effects of resistance training on functional performance, lower-limb loading distribution and balance in older women with total knee arthroplasty (TKA) and osteoarthritis (OA) in the contralateral knee. In addition, this older knee OA and TKA group (OKG) was compared to older (OG) and young women (YG) without musculoskeletal diseases who underwent the same resistance training program. METHODS: Twenty-three women divided into OKG (N = 7), OG (N = 8) and YG (N = 8) had their functional performance, lower-limb loading distribution and balance compared before and after 13 weeks of a twice-weekly progressive resistance training program. RESULTS: At baseline, the OKG showed lower functional performance and unilateral balance, and impaired lower-limb loading distribution compared to the OG and the YG (p<0.05). After resistance training, the OKG showed improvements in functional performance (∼13% in sit-to-stand and rising from the floor, ∼16% in stair-climbing and ∼23% in 6-minute walking (6 MW)), unilateral balance (∼72% and ∼78% in TKA and OA leg, respectively) and lower-limb loading distribution, which were greater than those observed in the OG and the YG. The OKG showed post-training 6 MW performance similar to that of the OG at baseline. Sit-to-stand performance and unilateral stand balance were further restored to post-training levels of the OG and to baseline levels of the YG. CONCLUSIONS: Resistance training partially restored functional, balance and lower-limb loading deficits in older women with TKA and OA in the contralateral knee. These results suggest that resistance training may be an important tool to counteract mobility impairments commonly found in this population. .

Exercise training as a preventive tool for age-related disorders: a brief review

Aging populations are a worldwide phenomenon affecting both developed and developing countries. This issue raises serious concerns for both governments and the general population. Regular participation in physical activity and/or exercise training programs can minimize the physiological alterations that occur during aging and may contribute to improvements in health and well-being. The present review will discuss the role of regular exercise training in preventing age-related physiological decline and, consequently, associated chronic diseases. Compelling evidence that regular exercise and/or physical activity can improve quality of life, prevent or control the development of chronic disease and increase life expectancy is shown. In summary, regular exercise training and/or physical activity has an important influence on aging and may help to prevent age-related disorders.

Exercise-induced improvements in cardiorespiratory fitness and heart rate response to exercise are impaired in overweight/obese postmenopausal women

OBJECTIVE: The purpose of this study was to compare the heart rate response to exercise and the exercise-induced improvements in muscle strength, cardiorespiratory fitness and heart rate response between normal-weight and overweight/obese postmenopausal women. METHODS: Sedentary women (n = 155) were divided into normal-weight (n = 79; BMI <25 kg/m²; 58.3 + 8.6 years) and overweight/obese (n = 76; BMI >25 kg/m²; 58.3 + 8.6 years) groups, and have their 1-repetition maximum strength (adjusted for body mass), cardiorespiratory fitness and heart rate response to a graded exercise test compared before and after 12 months of a three times-per-week exercise-training program. RESULTS: Overweight/obese women displayed decreased upper and lower extremity muscle strengths, decreased cardiorespiratory fitness, and lower peak and reserve heart rates compared to normal-weight women. After follow-up, both groups improved their upper (32.9 percent and 41.5 percent in normal-weight and overweight/obese women, respectively) and lower extremity(49.5 percent and 47.8 percent in normal-weight and overweight/obese women, respectively) muscle strength. However, only normal-weight women improved their cardiorespiratory fitness (6.6 percent) and recovery heart rate (5 bpm). Resting, reserve and peak heart rates did not change in either group. CONCLUSIONS: Overweight/obese women displayed impaired heart rate response to exercise. Both groups improved muscle strength, but only normal-weight women improved cardiorespiratory fitness and heart rate response to exercise. These results suggest that exercise-induced improvements in cardiorespiratory fitness and heart rate response to exercise may be impaired in overweight/obese postmenopausal women.

Muscle strength and exercise intensity adaptation to resistance training in older women with knee osteoarthritis and total knee arthroplasty

OBJECTIVES: To analyze muscle strength and exercise intensity adaptation to resistance training in older women with knee osteoarthritis and total knee arthroplasty. METHODS: Twenty-three community-dwelling women were divided into the following groups: older, with knee osteoarthritis and total knee arthroplasty in the contralateral limb (OKG; N= 7); older, without symptomatic osteoarthritis (OG; N= 8); and young and healthy (YG; N= 8). Muscle strength (1-repetition maximum strength test) and exercise intensity progression (workload increases of 5 percent-10 percent were made whenever adaptation occurred) were compared before and after 13 weeks of a twice-weekly progressive resistance-training program. RESULTS: At baseline, OKG subjects displayed lower muscle strength than those in both the OG and YG. Among OKG subjects, baseline muscle strength was lower in the osteoarthritic leg than in the total arthroplasty leg. Muscle strength improved significantly during follow-up in all groups; however, greater increases were observed in the osteoarthritic leg than in the total knee arthroplasty leg in OKG subjects. Greater increases were also seen in the osteoarthritic leg of OKG than in OG and YG. The greater muscle strength increase in the osteoarthritic leg reduced the interleg difference in muscle strength in OKG subjects, and resulted in similar posttraining muscle strength between OKG and OG in two of the three exercises analyzed. Greater exercise intensity progression was also observed in OKG subjects than in both OG and YG subjects. CONCLUSIONS: OKG subjects displayed greater relative muscle strength increases (osteoarthritic leg) than subjects in the YG, and greater relative exercise intensity progression than subjects in both OG and YG. These results suggest that resistance training is an effective method to counteract the lower-extremity strength deficits reported in older women with knee osteoarthritis and total knee arthroplasty.

Efeito do exercício aeróbico intervalado versus contínuo sobre o perfil hemodinâmico, metabólico e hormonal de mulheres jovens normotensas filhas de hipertensos / Effects of aerobic interval versus continuous aerobic exercise on hemodynamic, metabolic and hormonal profile in young normotensive women offspring of hypertensive parents

Histórico familiar de hipertensão está associado à anormalidades metabólicas e hemodinâmicas precoces. O exercício físico tem importante papel na prevenção e tratamento da hipertensão, mas as adaptações hemodinâmicas, metabólicas e hormonais em resposta ao treinamento físico não tem sido estudadas em indivíduos com histórico familiar de hipertensão. Nós comparamos os efeitos do treinamento com exercício intervalado (TI) e contínuo (CT) sobre variáveis hemodinâmicas, metabólicas e hormonais em normotensos filhos de hipertensos. Cinqüenta e nove mulheres saudáveis filhas de pais hipertensos, randomizadas para TI (n: 16; 24,4±3,8 anos), TC (n: 16; 26,6±4,9 years) ou grupo controle (CFH+; n: 12), e 15 mulheres jovens com pais normotensos tiveram a monitorização da pressão arterial ambulatorial (MAPA), velocidade de onda de pulso carótido-femoral (VOP), e bioquímica (colesterol total e frações, triglicérides, glicose, insulina e razão insulina/glicose) analisados antes e após 16 semanas de seguimento. Níveis de PA, nor-epinefrina (NE), endothelina-1 (ET-1) e nitrito/nitrato (NOx) também foram analisados durante um teste de esforço cardiopulmonar (TE). Treinamento físico foi realizado três vezes por semana durante 40 minutos à 65% do VO2PICO (TC) ou alternando 2 minutos à 55% com 1 minute à 85% VO2PICO (TI). Mapa, glicemia e níveis de colesterol foram similares entre os 4 grupos, mas os 3 grupos com histórico familiar positivo de hipertensão apresentaram maiores níveis de insulina e razão insulina/glicose, VOP, NE e ET-1, e menores níveis de NOx quando comparado com o grupo CFH-. Os dois tipos de exercício foram igualmente efetivos na melhora da MAPA, insulina e razão insulina/glicose; porém, TI foi mais efetivo para a melhora da VOP e condicionamento cardiorrespiratório, bem como para a melhora da resposta da PA, NE, ET-1 e NOx durante o TE...

Family history of hypertension is associated with early metabolic and hemodynamic abnormalities. Exercise training has an important role in the prevention and treatment of hypertension, but the hemodynamic, metabolic and hormonal adaptations to exercise training has not been studied in subjects with family history of hypertension. We compared the effects of aerobic interval (IT) and continuous exercise training (CT) on hemodynamic, metabolic and hormonal variables in offspring of hypertensive subjects. Fiftynine healthy women offspring of hypertensive subjects, randomized to IT (n: 16; 24.4±3.8 years), CT (n: 16; 26.6±4.9 years) or control group (CFH+; n: 12), and 15 young women with normotensive parents (CFH-) had their ambulatorial blood pressure (ABP), carotid-femoral pulse wave velocity (PWV), and biochemistry (total cholesterol and fractions, triglycerides, glucose, insulin and insulin-to-glucose ratio) analyzed before and after a 16- week follow-up. BP, nor-epinephrine (NE), endothelin-1 (ET-1) and nitrite/nitrate (NOx) levels were also analyzed during a graded exercise test (GXT). Exercise training was performed three times-a-week for 40 minutes at 65% of VO2PEAK (CT) or alternating 2 minutes at 55% with 1 minute at 85% VO2PEAK (IT). ABP, glucose and cholesterol levels were similar among all groups, but the 3 groups with positive family history of hypertension displayed increased insulin and insulin-to-glucose ratio, PWV, NE and ET-1, and decreased NOx when compared to CFH-. The 2 exercise groups were equally effective in improving ABP, insulin and insulin-to-glucose ratio; however, IT was superior to CT at improving PWV and cardiorespiratory fitness, as well as the BP, NE, ET-1 and NOx during the GXT. After the follow-up, IT group displayed insulin and insulin-to-glucose ratio, PWV, NE and ET-1 decreased and NOx increased than the CFH+, but only ET-1 was decreased in CT than CFH+. In conclusion, both exercise training programs improved hemodynamic...

Heart rate dynamics during a treadmill cardiopulmonary exercise test in optimized beta-blocked heart failure patients

BACKGROUND: Calculating the maximum heart rate for age is one method to characterize the maximum effort of an individual. Although this method is commonly used, little is known about heart rate dynamics in optimized beta-blocked heart failure patients. AIM: The aim of this study was to evaluate heart rate dynamics (basal, peak and percent heart rate increase) in optimized beta-blocked heart failure patients compared to sedentary, normal individuals (controls) during a treadmill cardiopulmonary exercise test. METHODS: Twenty-five heart failure patients (49±11 years, 76 percent male), with an average LVEF of 30±7 percent, and fourteen controls were included in the study. Patients with atrial fibrillation, a pacemaker or noncardiovascular functional limitations or whose drug therapy was not optimized were excluded. Optimization was considered to be 50 mg/day or more of carvedilol, with a basal heart rate between 50 to 60 bpm that was maintained for 3 months. RESULTS: Basal heart rate was lower in heart failure patients (57±3 bpm) compared to controls (89±14 bpm; p<0.0001). Similarly, the peak heart rate ( percent maximum predicted for age) was lower in HF patients (65.4±11.1 percent) compared to controls (98.6±2.2; p<0.0001). Maximum respiratory exchange ratio did not differ between the groups (1.2±0.5 for controls and 1.15±1 for heart failure patients; p=0.42). All controls reached the maximum heart rate for their age, while no patients in the heart failure group reached the maximum. Moreover, the percent increase of heart rate from rest to peak exercise between heart failure (48±9 percent) and control (53±8 percent) was not different (p=0.157). CONCLUSION: No patient in the heart failure group reached the maximum heart rate for their age during a treadmill cardiopulmonary exercise test, despite the fact that the percentage increase of heart rate was similar to sedentary normal subjects. A heart rate increase in optimized beta-blocked...

Exercício físico e síndrome metabólica / Physical exercise and metabolic syndrome

A prática regular de atividade física tem sido recomendada para a prevenção e reabilitação de doenças cardiovasculares e outras doenças crônicas por diferentes associações de saúde no mundo, como o American College of Sports Medicine, os Centers for Disease Control and Prevention, a American Heart Association, o National Institutes of Health, o US Surgeon General, a Sociedade Brasileira de Cardiologia, entre outras. Estudos epidemiológicos têm demonstrado relação direta entre inatividade física e a presença de múltiplos fatores de risco como os encontrados na síndrome metabólica. Entretanto, tem sido demonstrado que a prática regular de exercício físico apresenta efeitos benéficos na prevenção e tratamento da hipertensão arterial, resistência à insulina, diabetes, dislipidemia e obesidade. Com isso, o condicionamento físico deve ser estimulado para todos, pessoas saudáveis e com múltiplos fatores de risco, desde que sejam capazes de participar de um programa de treinamento físico. Assim como a terapêutica clínica cuida de manter a função dos órgãos, a atividade física promove adaptações fisiológicas favoráveis, resultando em melhora da qualidade de vida.

Síndrome metabólica: abordagem do educador físico / Metabolic syndrome: physical educator approach

A prática regular de atividade física tem sido recomendada para a prevenção e a reabilitação de doenças cardiovasculares e outras doenças crônicas por diferentesassociações de saúde no mundo, como "American College of Sports Medicine", "Centers for Disease Control and Prevention", "American Heart Association", "NationalInstitutes of Health", "US Surgeon General" e Sociedade Brasileira de Cardiologia.Estudos epidemiológicos têm demonstrado relação direta entre inatividade física epresença de múltiplos fatores de risco como os encontrados na síndrome metabólica. Os efeitos benéficos do exercício físico têm sido demonstrados na prevenção e no tratamento da hipertensão arterial, na resistência à insulina, no diabetes, na dislipidemia e na obesidade. O condicionamento físico deve ser estimulado para todas as pessoas saudáveis e com múltiplos fatores de risco, desde que sejam capazesde participar de um programa de treinamento físico. Assim como a terapêutica clínica cuida de manter a função dos órgãos, a atividade física promove adaptaçõesfisiológicas favoráveis, resultando em melhora da qualidade de vida.