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.

Repercussão da oxigenoterapia domiciliar na qualidade de vida de pacientes com doença pulmonar obstrutiva crônica / Repercussion of home oxygen therapy on the quality of life of patients with chronic obstructive pulmonary disease

A hipoxemia encontrada na Doença Pulmonar Obstrutiva Crônica (DPOC) deve-se a alterações de ventilação/perfusão, então oferecer uma fração inspiratória de oxigênio maior é a solução encontrada. Entretanto, embora aumente a sobrevida, o uso prolongado do oxigênio diminui a independência do indiví­duo, e estudar o impacto dessa intervenção na qualidade de vida (QV) desses pacientes é muito importante para a indicação na prática clí­nica. Objetivo: Identificar as implicações do uso da oxigenoterapia domiciliar na QV do DPOC. Material e métodos: Realizado o levantamento de artigos cientí­ficos nas bases de dados Pubmed, Lilacs e Scielo, com a string: "(COPD) AND (Oxygen therapy) AND (quality of life)", sendo incluí­dos ensaios clí­nicos randomizados, quasi randomizados, e observacionais, nos idiomas inglês e português, publicados de 2000 a 2017. Resultados: Nove estudos foram inseridos, sendo três ensaios clí­nicos randomizados e controlados. Apenas um estudo identificou melhora na QV, dois não encontraram diferença entre os grupos e quatro apresentaram piores escores com a oxigenoterapia. Dois estudos avaliaram a influência do tipo de dispositivo na QV. Conclusão: A oxigenoterapia parece piorar a qualidade de vida dos pacientes com DPOC. Porém, poucos foram os estudos encontrados e nem todos com o melhor desenho experimental, o que prejudica a confirmação dos resultados. (AU)

The hypoxemia observed in Chronic Obstructive Pulmonary Disease (COPD) is due to ventilation/perfusion changes, so a greater inspiratory fraction of oxygen could be the solution. However, while increasing survival, prolonged use of oxygen decreases the independence, and studying the impact of this intervention on the quality of life (QoL) of these patients is very important for indication in clinical practice. Objective: To identify the implications of the use of home oxygen therapy in COPD QoL. Methods: The search for scientific articles in the Pubmed, Lilacs and Scielo databases was performed with the string: "(COPD) AND (Oxygen therapy) AND (quality of life)", including randomized, quasi-randomized, and observational studies, published in English and Portuguese, from 2000 to 2017. Results: Nine studies were included, three of which were randomized and controlled clinical trials. Only one study identified improvement in QoL, two found no difference between groups, and four had worse scores with oxygen therapy. Two studies evaluated the influence of device type on QoL. Conclusion: Oxygen therapy seems to worsen the quality of life of patients with COPD. However, few studies have been found and not all with the best experimental design, which impairs the confirmation of the results. (AU)