Influence of population and exercise protocol characteristics on hemodynamic determinants of post-aerobic exercise hypotension

Due to differences in study populations and protocols, the hemodynamic determinants of post-aerobic exercise hypotension (PAEH) are controversial. This review analyzed the factors that might influence PAEH hemodynamic determinants, through a search on PubMed using the following key words: “postexercise” or “post-exercise” combined with “hypotension”, “blood pressure”, “cardiac output”, and “peripheral vascular resistance”, and “aerobic exercise” combined only with “blood pressure”. Forty-seven studies were selected, and the following characteristics were analyzed: age, gender, training status, body mass index status, blood pressure status, exercise intensity, duration and mode (continuous or interval), time of day, and recovery position. Data analysis showed that 1) most postexercise hypotension cases are due to a reduction in systemic vascular resistance; 2) age, body mass index, and blood pressure status influence postexercise hemodynamics, favoring cardiac output decrease in elderly, overweight, and hypertensive subjects; 3) gender and training status do not have an isolated influence; 4) exercise duration, intensity, and mode also do not affect postexercise hemodynamics; 5) time of day might have an influence, but more data are needed; and 6) recovery in the supine position facilitates systemic vascular resistance decrease. In conclusion, many factors may influence postexercise hypotension hemodynamics, and future studies should directly address these specific influences because different combinations may explain the observed variability in postexercise hemodynamic studies.

Intolerância ao exercício em pacientes com doença pulmonar obstrutiva crônica / Exercise intolerance in chronic obstructive pulmonary disease patients

A doença pulmonar obstrutiva crônica é uma doença irreversível, de elevada incidência e alto custo para os serviços públicos e privados de saúde. Essa doença restringe a capacidade física do indivíduo, o que contribui para hospitalizações frequentes e elevada mortalidade. O objetivo deste artigo é descrever as características da doença pulmonar obstrutiva crônica e os principais fatores que limitam a tolerância ao exercício nessa população. A intolerância ao exercício reduz a capacidade de pacientes com doença pulmonar obstrutiva crônica em realizarem suas atividades de vida diária, favorecendo o desenvolvimento de depressão, isolamento social e piora da qualidade de vida, entre outras complicações. Atualmente, as evidências científicas suportam a necessidade de que esses pacientes sejam submetidos a programas de reabilitação pulmonar, que incluem, entre outras atividades, a prática de exercício físico. Entretanto, para a compreensão da intervenção e obtenção de resultados mais efetivos, é fundamental o entendimento das alterações respiratórias e sistêmicas observadas na doença pulmonar obstrutiva crônica, assim como as razões que levam à inatividade física

Chronic obstructive pulmonary disease is a high-incidence, irreversible disease, which is also expensive for the public and private health services. This disease limits the physical capacity of the patients, resulting in frequent hospitalizations and high mortality. The aim of this article is to describe the characteristics of chronic obstructive pulmonary disease and the main factors that limit exercise tolerance in this population. Exercise intolerance reduces the ability of chronic obstructive pulmonary disease patients to carry out their activities of daily living, contributing to the development of depression and social isolation, worsening their quality of life. Currently, scientific evidence supports the fact that these patients need to attend pulmonary rehabilitation programs, which include among other activities, the practice of physical exercise. However, to understand the intervention and achieve more effective results, it is essential to understand the respiratory and systemic changes seen in chronic obstructive pulmonary disease, as well as the reasons that lead to physical inactivity.