Haemophilia and exercise.

One of the most important objectives of intervention programs for persons with haemophilia (PWH) is to improve their quality of life. Regular physical activity has been recommended as an adjunct to conventional treatment, with positive results in the prevention of joint problems and bleeding, in addition to the improvement in cardiovascular function, muscle strength, and body composition. The objective of the present review was to present the benefits of aerobic and resistance training programs in PWH, as well to discuss the best exercise dose-response in the different levels of disease severity. We considered randomized controlled trials, study cases and literature reviews from MEDLINE and Highwire databases. After a detailed analysis of the studies involving exercise for PWH, it can be concluded that this intervention elicits some benefits for physical fitness and blood coagulation mechanisms, suggesting the application of physical training as a non pharmacological treatment in association with conventional treatment. Adequate and periodized resistance training considering the disease severity, accompanied by physical education professionals could improve muscle strength, balance and proprioception. In addition, aerobic training could reduce the risks of obesity and several metabolic and cardiovascular diseases. Exercise can improve several outcomes of quality in PWH.

Effect of 12 weeks of resistance exercise on post-exercise hypotension in stage 1 hypertensive individuals.

Post-exercise hypotension (PEH), the reduction of blood pressure (BP) after a single bout of exercise, is of great clinical relevance. As the magnitude of this phenomenon seems to be dependent on pre-exercise BP values and chronic exercise training in hypertensive individuals leads to BP reduction; PEH could be attenuated in this context. Therefore, the aim of the present study was to investigate whether PEH remains constant after resistance exercise training. Fifteen hypertensive individuals (46 ± 8 years; 88 ± 16 kg; 30 ± 6% body fat; 150 ± 13/93 ± 5 mm Hg systolic/diastolic BP, SBP/DBP) were withdrawn from medication and performed 12 weeks of moderate-intensity resistance training. Parameters of cardiovascular function were evaluated before and after the training period. Before the training program, hypertensive volunteers showed significant PEH. After an acute moderate-intensity resistance exercise session with three sets of 12 repetitions (60% of one repetition maximum) and a total of seven exercises, BP was reduced post-exercise (45-60 min) by an average of aproximately -22 mm Hg for SBP, -8 mm Hg for DBP and -13 mm Hg for mean arterial pressure (P<0.05). However, this acute hypotensive effect did not occur after the 12 weeks of training (P>0.05). In conclusion, our data demonstrate that PEH, following an acute exercise session, can indeed be attenuated after 12 weeks of training in hypertensive stage 1 patients not using antihypertensive medication.

Assessment of aerobic capacity during swimming exercise in ob/ob mice.

Obesity is a highly prevalent condition associated with several diseases. Physical exercise has been considered as a non-pharmacological tool in the treatment of obesity. However, several aspects underlying exercise evaluation and prescription in obesity and associated pathologies are still under investigation. Although many research involving exercise have been performed in animal models, there is a lack of protocols for aerobic capacity assessment in obese animals, such as the ob/ob mice. This study aimed the following: (i) to verify the possibility of determining the lactate threshold (LT) on swimming exercise in ob/ob mice and in non-obese heterozygote mice (ob/OB), through visual inspection (vLT) and polynomial adjustment (pLT); and (ii) to verify if the LT determined through these protocols corresponds to the maximal lactate steady state (MLSS). Eight ob/ob and ten ob/OB mice performed an incremental exercise test to determine vLT and pLT as well as constant-load exercise bouts to determine MLSS. There were no within-group differences between vLT, pLT and MLSS [ob/ob: ~5.3% body weight (BW); ob/OB: ~3·6%BW] with a high agreement among protocols. In conclusion, the identification of the LT and MLSS intensities was possible for both groups. These data suggest that the proposed protocols may be used in new research on the effects of different exercise intensities on some aspects of obesity.

Acute resistance exercise is more effective than aerobic exercise for 24h blood pressure control in type 2 diabetics.

AIM: The study aimed to analyze blood pressure (BP) responses in individuals with type 2 diabetes (T2D) over a 24h period following resistance (RES) and aerobic (AER) exercise. METHODS: Ten adults with T2D (age: 55.8 ± 7.7 years; weight: 79.4 ± 14.0 kg; fasting glucose: 133.0 ± 36.7 mg.dL⁻¹) underwent: (1) AER: 20 min of cycling at 90% lactate threshold (90% LT); (2) RES: three laps of a circuit of six exercises with eight repetitions at 70% 1-RM and 40s of recovery; and (3) a control session of no exercise. Heart rate (HR), and systolic (SBP), diastolic (DBP), mean arterial (MAP) and pulse (PP) BP, as well as lactataemia (Lac), VO(2), respiratory exchange ratio (RER) and rate of perceived exertion (RPE) were measured at rest, during exercise and control (CON) periods, and 60min after interventions. After each session, BP was also monitored over a 24h period. RESULTS: Peak Lac (RES: 6.4 ± 1.4mM; AER: 3.8 ± 1.2mM), RER (RES: 1.1 ± 0.1; AER: 0.9 ± 0.1) and RPE (RES: 14.0 ± 1.3; AER: 11.0 ± 2.3) were higher following the RES session (P < 0.05). Similar VO2 (~70% VO(2peak)) was reached during AER and RES sessions (14.0 ± 3.0 vs 14.3 ± 1.6 mL.kg.min⁻¹; P > 0.05). Compared with CON, only RES elicited post-exercise BP reduction that lasted 8h after exercise. Also, in comparison to pre-exercise rest, the BP dip during sleep was greater following RES (P < 0.05). CONCLUSION: A single exercise bout decreases BP in T2D patients over a 24h period, with RES being more effective than AER exercise for BP control.

Effect of type 2 diabetes on plasma kallikrein activity after physical exercise and its relationship to post-exercise hypotension.

AIM: The present study was undertaken to determine the effects of type 2 diabetes (T2D) on plasma kallikrein activity (PKA) and postexercise hypotension (PEH). METHODS: Ten T2D patients (age: 53.6±1.3 years; body mass index: 30.6±1.0kg/m(2); resting blood glucose: 157.8±40.2mgdL(-1)) and 10 non-diabetic (ND) volunteers (age: 47.5±1.0 years; body mass index: 28.3±0.9kg/m(2); resting blood glucose: 91.2±10.5mgdL(-1)) underwent two experimental sessions, consisting of 20min of rest plus 20min of exercise (EXE) at an intensity corresponding to 90% of their lactate threshold (90LT) and a non-exercise control (CON) session. Blood pressure (BP; Microlife BP 3AC1-1 monitor) and PKA were measured during rest and every 15min for 135min of the postexercise recovery period (RP). RESULTS: During the RP, the ND individuals presented with PEH at 30, 45 and 120min (P<0.05) while, in the T2D patients, PEH was not observed at any time. PKA increased at 15min postexercise in the ND (P<0.05), but not in the T2D patients. CONCLUSION: T2D individuals have a lower PKA response to exercise, which probably suppresses its hypotensive effect, thus reinforcing the possible role of PKA on PEH.

Blood glucose minimum predicts maximal lactate steady state on running.

This study analyzed if the running speed corresponding to glucose minimum (GM) could predict the maximal lactate steady state (MLSS). Thirteen physically active men (25.2+/-4.2 years, 73.4+/-8.0 kg, 180.0+/-1.0 cm) completed three running tests on different days: 1) a 1 600-m time trial to calculate the average speed; 2) after 10-min of recovery from a 150-m sprint to elevate [lac], participants performed 6 series of 800-m respectively at 78, 81, 84, 87, 90 and 93% of the 1 600-m speed to identify the lactate minimum (LM) and GM speeds and 3) 2-4 constant intensity exercise sessions for the MLSS. Repeated measures ANOVA showed no differences between running speeds associated to the GM (201.7+/-23.8 m.min (-1)), LM (200.0+/-23.9 m.min (-1)) and MLSS (201.5+/-23.1 m.min (-1)), with high correlation between GM vs. LM (r=0.984), GM vs. MLSS (r=0.947) and LM vs. MLSS (r=0.961) (P<0.01). Bland and Altman plots showed good agreement [Bias (+/-95% CI)] for MLSS and GM [0.2(15.3) m.min (-1)], MLSS and LM [-1.4(13.2) m.min (-1)], as well as for LM and GM [1.7(8.5) m.min (-1)]. These running speeds occurred at approximately 84.4% of 1 600-m speed, which would have practical applications for exercise prescription. We concluded that GM running speed is a good predictor of the MLSS for physically active individuals.

Polynomial modeling for the identification of lactate minimum velocity by different methods.

AIM: The lactate minimum (LM) protocol has been used to assess aerobic fitness and to predict exercise intensity associated with the maximal blood lactate steady state. The aim of this study was to compare different methods to identify the lactate minimum velocity (LMV) on cycling. METHODS: Fourteen male cyclists (26.8+/-4.5 years; 173.2+/-6.1 cm; 67.3+/-5.2 kg; 5,8+/-2.9 years of training) performed the LM test in a velodrome. The protocol consisted of an all out 2 km time trial to elevate blood lactate (bLAC), followed by 8 min of recovery and then 6 bouts of 2 km starting 5 kmxh(-1) below the individual mean velocity for the 6 km performance. The velocity was incremented by 1 kmxh(-1) at each bout with 25 microL of capillary blood being collected for bLAC measurements (YSI 2700 STAT). The LMV was identified visually (vLMV), and by applying a second grade polynomial function on 6 (pLMV(6)) and 3 (pLMV(3)) incremental bouts. Additionally, a method where the bLACx work velocity(-1) quotients (LMVQ) were plotted against the correspondent velocity during the incremental test, identified the LMV by considering 6 (LMVQ(6)) or 3 bouts (LMVQ(3)). RESULTS: ANOVA showed no differences between vLMV (33.1+/-2.5 kmxh(-1)), pLMV(6) (32.9+/-2.5 kmxh(-1)), pLMV(3) (33.2+/-2.3 kmxh(-1)), LMVQ(6) (32.8+/-2.5 kmxh(-1)) and LMVQ(3) (33.4+/-2.3 kmxh(-1)), with high correlation among them. CONCLUSIONS: It was possible to identify the LMV by the methods proposed in the present study, even when the results of only 3 bouts of the test were modeled by polynomial function. Such an approach enables a more practical and economical test in addition to minimizing the discomfort due to several blood collections.

Respostas cardiovasculares durante a postura sentada da Reeducação Postural Global (RPG) / Cardiovascular responses in the seated posture of the Global Postural Reeducation (GPR) method

OBJETIVO: Avaliar as respostas da freqüência cardíaca (FC), pressão arterial sistólica (PAS), diastólica (PAD), média (PAM) e duplo produto (DPr), durante a postura sentada do método de Reeducação Postural Global (RPG). MATERIAIS E MÉTODOS: Nove voluntárias saudáveis (23±2,1 anos, 56,4±7,8kg, 1,61±0,05m, 21,6±2,4kg.m2-1), inexperientes na prática do método RPG, foram submetidas a uma sessão de RPG na postura sentada, realizada em três fases: repouso pré-postura, execução da postura e recuperação pós-postura. No repouso e na recuperação, as voluntárias permaneceram sentadas por 20 minutos, sendo PA e FC verificadas a cada cinco minutos. A fase de execução da postura foi realizada em três séries e mantida por três minutos cada, com intervalo de um minuto entre elas. A verificação da PA e da FC foi realizada a cada um minuto e 30 segundos de execução da postura. RESULTADOS: Os valores de PAS, PAD, PAM e DPr foram significativamente maiores (p<0,05) do terceiro ao nono minuto da execução da postura (154±14, 107±11, 122±9mmHg e 16.478±2.802mmHg.min-1) quando comparados aos valores de repouso pré-postura (109±10, 74±7, 85±8mmHg e 9.374±1.687mmHg.min-1) e aos valores de recuperação pós-postura. Porém, estes valores retornaram aos valores de repouso nos primeiros cinco minutos de recuperação pós-postura. Durante a execução da postura, a FC não foi estatisticamente diferente da FC de repouso pré-postura. CONCLUSÕES: Elevações significativas da PAS, PAD, PAM e DPr foram observadas durante a execução da postura sentada da RPG empregada nesse estudo, mas retornaram aos valores de repouso nos primeiros cinco minutos de recuperação pós-postura.

OBJECTIVE: To evaluate heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP) and double product (DP) responses in the seated posture of the Global Postural Reeducation (GPR) method. METHODS: Nine healthy female volunteers (23±2.1 years; 56.4±7.8kg; 1.61±0.05m, 21.6±2.4kg/m²), without experience of the GPR, method underwent a treatment session in the seated posture. It was a three-step experiment: pre-posture resting, posture maintenance and post-posture recovery. In both the resting and the recovery step, the volunteers remained seated for 20 minutes and arterial pressure and HR were measured every five minutes. The posture maintenance step lasted for three minutes and was implemented three times with one-minute intervals between implementations. Arterial pressure and HR were measured every 1.5 minutes, while the posture was being maintained. RESULTS: The SAP, DAP, MAP and DP values were significantly greater (p<0.05) from the third to the ninth minute of maintaining the posture (154±14, 107±11, 122±9mmHg and 16,478±2,802mmHg/min) in comparison with the pre-posture resting values (109±10, 74±7, 85±8mmHg and 9,374±1,687mmHg/min) and the post-posture recovery values. However, these values returned to the resting values within the first five minutes of post-posture recovery. The HR while maintaining the posture was not statistically different from the pre-posture resting HR. CONCLUSIONS: Significant increases in SAP, DAP, MAP and DP were observed while maintaining the seated posture of the GPR method that was used in this study, but these values returned to the resting values within the first five minutes of post-posture recovery.

Identificação do limiar anaeróbio em indivíduos com diabetes tipo-2 sedentários e fisicamente ativos / Identification of the anaerobic threshold in sedentary and physically active individuals with type 2 diabetes

OBJETIVO: Comparar intensidades de limiar anaeróbio (LA) obtidas a partir do lactato, ventilação e glicemia em diabéticos tipo-2 ativos (DA) e sedentários (DS) e não-diabéticos ativos (NDA), e correlacionar variáveis metabólicas, hemodinâmicas e de composição corporal com o LA. METODOLOGIA: Grupos de DS (n= 09, 56,7 ± 11,9 anos), DA (n= 09, 50,6 ± 12,7 anos) e NDA (n= 10, 48,1 ± 10,8 anos) foram submetidos a um teste em cicloergômetro com incrementos de 15W até a exaustão. Freqüência cardíaca, pressão arterial (PA), percepção de esforço, lactato, glicemia e variáveis ventilatórias foram mensuradas nos 20seg finais de cada estágio de 3min para determinação dos limiares de lactato, ventilatório e glicêmico. RESULTADOS: As intensidades associadas ao LA identificado pelos diferentes métodos não diferiram entre si (p> 0,05). As intensidades absolutas foram menores para o grupo DS em relação aos grupos ativos (p< 0,05), não sendo observadas diferenças entre os grupos para as intensidades relativas ao consumo máximo de oxigênio ( por centoVO2 pico) e potência máxima ( por centoPpico) de ocorrência do LA. Observou-se correlação significativa entre LA e o percentual de gordura (r= -0,52), com tendência à correlação entre o LA e a glicemia ambulatorial (r= -0,33). Variáveis hemodinâmicas e LA não demonstraram correlações. CONCLUSÃO: O LA foi identificado a partir das técnicas estudadas em diabéticos tipo-2 e não-diabéticos. Apesar das diferenças entre grupos para as intensidades absolutas (Watts), a patologia pareceu não influenciar as intensidades relativas em que o LA foi observado. O LA apresentou correlação com a composição corporal e tendência a se correlacionar com a glicemia ambulatorial, sugerindo-se, com isso, o LA como um parâmetro importante na avaliação clínica destes pacientes.

OBJECTIVE: To compare anaerobic threshold (AT) intensities determined from blood lactate, blood glucose and ventilatory responses among sedentary (SD) and physically active (AD) type-2 diabetics and active non-diabetics (AND), and to correlate metabolic, hemodynamic and body composition variables with the AT. METHOD: The SD (n= 9, 56.7 ± 11.9 years), AD (n= 9, 50.6 ± 12.7 years) and AND (n= 10, 48.1 ± 10.8 years) groups performed a cycle ergometer test with increases of 15 watts every three minutes until exhaustion. Heart rate, arterial pressure, perceived exertion, blood lactate, blood glucose and ventilatory variables were measured during the last 20 seconds of each incremental stage, to determine the lactate, ventilatory and glucose thresholds. RESULTS: The AT intensities identified by the different methods did not differ from each other (p> 0.05). However, the absolute intensities were lower for SD than for the active groups (p< 0.05). No differences in intensity were found between the groups in relation to maximum oxygen consumption ( percentVO2 peak) and maximum power ( percentPpeak) at which the AT was observed. There was a significant correlation between AT and percentage fat (r= -0.52), and there was a trend towards correlation between AT and ambulatory blood glucose (r= -0.33). The hemodynamic variables did not show any correlations with AT. CONCLUSION: The AT was identified by means of the techniques studied, among type 2 diabetics and non-diabetics. Despite the differences between the groups with regard to absolute intensities (watts), diabetes did not appear to influence the relative intensities at which the AT was observed. The AT presented a correlation with body composition and a trend towards correlation with ambulatory blood glucose, thus suggesting that the AT is an important parameter in clinical assessments for such patients.

Relationships and significance of lactate minimum, critical velocity, heart rate deflection and 3 000 m track-tests for running.

AIM: The running velocities associated to lactate minimum (V(lm)), heart rate deflection (V(HRd)), critical velocity (CV), 3.000 m (V(3000)) and 10 000 m performance (V10km) were compared. Additionally the ability of V(lm) and V(HRd) on identifying sustainable velocities was investigated. METHODS: Twenty runners (28.5+/-5.9 y) performed 1) 3,000 m running test for V3000; 2) an all-out 500 m sprint followed by 6x800 m incremental bouts with blood lactate ([lac]) measurements for V(lm); 3) a continuous velocity-incremented test with heart rate measurements at each 200 m for V(HRd); 4) participants attempted to 30 min of endurance test both at V(lm)(ETV(lm)) and V(HRd)(ETV(HRd)). Additionally, the distance-time and velocity-1/time relationships produced CV by 2 (500 m and 3 000 m) or 3 predictive trials (500 m, 3,000 m and distance reached before exhaustion during ETV(HRd)), and a 10 km race was recorded for V10km. RESULTS: The CV identified by different methods did not differ to each other. The results (m.min(-1)) revealed that V(lm) (281+/-14.8)