Gamification as a Tool for Promoting Physical Exercise and Healthy Eating Habits in Healthcare Worker Women: Effects on Cardiometabolic Health and Physical Fitness at Workplace.

PURPOSE: To evaluate the effectiveness of gamified versus nongamified health promotion interventions on cardiometabolic health and fitness parameters in healthcare worker women. DESIGN: Randomized parallel group trial. SETTING: A public outpatient health center in Brazil. SUBJECTS: Women employees (included: n = 29; lost to follow-up: n = 1; analyzed: n = 28). INTERVENTIONS: 8 weeks of gamified (n = 15) or nongamified (n = 13) interventions, consisting of health lectures, nutritional counseling, and supervised exercise training. The gamified group was divided into teams that received points based on completion of health goals/tasks. MEASURES: Anthropometric, cardiometabolic and physical fitness parameters. ANALYSIS: Two-way ANOVA with repeated measures (group vs. time), and Bonferroni post hoc tests. RESULTS: Body mass (-1.5 ± 1.5 kg), waist circumference (-1.6 ± 3.0 cm), HbA1C (-.2 ± .3%), triglycerides (-21.5 ± 48.2 mg/dl), systolic (-11.1 ± 7.9 mmHg) and diastolic (-7.1 ± 5.8 mmHg) blood pressure, as well as sit and reach (3.9 ± 3.0 cm) and six-minute walking (56 ± 37 m) performance improved (P < .05) only after the gamified intervention. Sit-to-stand performance improved after both the gamified (-1.18 ± 1.24 s) and nongamified (-1.49 ± 1.87 s) interventions. CONCLUSION: The gamified intervention was more effective than the nongamified intervention for improving cardiometabolic and physical fitness parameters, suggesting that gamification may be an effective tool for promoting health in healthcare worker women.

Hemodynamic response to exercise is impaired in individuals with Parkinson's disease.

BACKGROUND: The aim of this study was to assess hemodynamic and cardiac autonomic response to high-intensity interval exercise (HIIE) versus moderate-intensity continuous exercise (MICE) in individuals with Parkinson's disease (PD). METHODS: Twelve individuals (six men) with PD were randomly assigned to perform HIIE (4 min of warm-up followed by 21 min alternating 1 min at levels 15-17 with 2 min at levels 9-11 of rating of perceived exertion [RPE] in a cycle ergometer), MICE (4 min of warm-up followed by 26 min at levels 11-14 of RPE in a cycle ergometer) and control (CON; 30 min of sitting rest) interventions in separate days. Heart rate (HR), blood pressure (BP), endothelial reactivity and heart rate variability (HRV) were assessed before, immediately after and 45 min after each intervention. HR and exercise workload were measured during each intervention. RESULTS: Despite the within (high- vs. low-intensity intervals of HIIE) and between (HIIE vs. MICE) differences in workload during exercise sessions, HR was not different between high- (average HR=98±18 bpm) and low-intensity (average HR 97±19 bpm) intervals of HIIE, as well as between HIIE (average HR=97±18 bpm) and MICE (average HR=93±19 bpm) throughout the exercise. There were significant, but small, increases (P<0.01) in HR and systolic BP at post HIIE and MICE, which returned to levels similar to preintervention during recovery. There were no within- and between-intervention differences in diastolic BP, endothelial reactivity and HRV. CONCLUSIONS: The present results suggest that hemodynamic response to exercise is impaired in individuals with PD.

Prescribing high-intensity interval exercise by rating of perceived exertion in young individuals.

BACKGROUND: We tested the hypothesis that the 6 to 20 rating of perceived exertion (RPE) is a cost-effective tool similar to heart rate (HR) response to cardiopulmonary exercise test for prescribing and self-regulating high-intensity interval exercise (HIIE). In this context, we analyzed if health-related responses to exercise are similar between HIIE prescribed and self-regulated by RPE (HIIERPE) and HIIE prescribed and regulated by HR response to cardiopulmonary exercise test (HIIEHR). METHODS: Twelve young (21±2 years) sedentary or insufficiently active individuals (weekly levels ˂150 minutes or 75 minutes of moderate- or vigorous-intensity physical activity, respectively) were randomly assigned to perform HIIERPE (25 minutes), HIIEHR (25 minutes) and control session (25 minutes of seated resting). Blood pressure, HR, and arterial stiffness (pulse wave velocity) were measured before, immediately after, and 30 minutes after each intervention. HR, speed, and distance were measured during exercise sessions. 24-hours ambulatory blood pressure was measured after each intervention. RESULTS: Exercise HR, speed, and distance, as well as blood pressure response to exercise were not different between HIIERPE and HIIEHR. Pulse wave velocity reduced (P<0.05) at postintervention in both HIIERPE (0.28±0.17 m/s) and HIIEHR (0.27±0.11 m/s). However, pulse wave velocity at recovery was lower than pre-intervention only during HIIERPE (0.30±0.10 m/s). CONCLUSIONS: These results suggest that RPE is a cost-effective tool for prescribing self-regulating HIIE and improving health-related variables in young individuals.

Hemodynamic response to heated water immersion in older individuals with hypertension.

The aim of this study was to evaluate blood pressure (BP), heart rate, arterial stiffness and endothelial reactivity responses to heated water immersion in older individuals with hypertension. Thirty-five sedentary individuals (67 ± 5 years) under treatment for hypertension were randomly assigned to water-based [n = 20; 30 min of seated resting in a heated swimming pool (30-32 °C)] or land-based group [n = 15; 30 min of seated resting in a quiet room with controlled temperature (21-23 °C)]. BP, heart rate, arterial stiffness and endothelial reactivity were measured before, immediately after (post) and 45 min after (recovery) each session. Heart rate reduced (P < 0.05) during the land-based session, and the reduction was maintained at post (~7 bpm) and recovery (~9 bpm), but no heart rate changes occurred during and after the water-based session. Systolic/diastolic BP increased (P = <0.001) at post (~29/10 mmHg) and recovery (~10/7 mmHg) in the water-based group, but not in the land-based group. No significant changes in pulse wave velocity and endothelial reactivity occurred in both groups. These results suggest that the hemodynamic response to heated water immersion should be taken into account when assessing the effect of heated water-based exercise on postexercise hypotension in older individuals with hypertension.

Cardiac reinnervation affects cardiorespiratory adaptations to exercise training in individuals with heart transplantation.

PURPOSE: The purpose of this study was to investigate the hemodynamic and cardiorespiratory adaptations to exercise in individuals with heart transplantation with evidence of cardiac reinnervation (cardiac reinnervation group) versus without evidence of cardiac reinnervation (no cardiac reinnervation group). METHODS: Sedentary individuals with heart transplantation (age = 45.5 ± 2.2 years; time elapsed since surgery = 6.7 ± 0.7 years) were divided into the cardiac reinnervation (n = 16) and no cardiac reinnervation (n = 17) groups according to their heart rate response to cardiopulmonary exercise testing. The 24-hour ambulatory blood pressure, carotid-femoral pulse wave velocity, and cardiorespiratory fitness were assessed before and after 12 weeks of a thrice-weekly exercise program (five minutes of warm-up, 30 min of endurance exercise, one set of 10-15 reps in five resistance exercises, and five minutes of cool-down). RESULTS: The cardiac reinnervation group had reduced (p < 0.01) 24-hour systolic/diastolic blood pressure (7/9 mm Hg), daytime systolic/diastolic blood pressure (9/10 mm Hg) and nighttime diastolic blood pressure (6 mm Hg) after training. The no cardiac reinnervation group reduced (p < 0.05) only 24-hour (5 mm Hg), daytime (5 mm Hg) and nighttime (6 mm Hg) diastolic blood pressure after training. Hourly analysis showed that the cardiac reinnervation group reduced systolic/diastolic blood pressure for 10/21 h, while the no cardiac reinnervation group reduced systolic/diastolic blood pressure for only 3/11 h. The cardiac reinnervation group also improved both maximal oxygen consumption (10.8%) and exercise tolerance (13.4%) after training, but the no cardiac reinnervation group improved only exercise tolerance (9.9%). Pulse wave velocity did not change in both groups. CONCLUSION: There were greater improvements in ambulatory blood pressure and maximal oxygen consumption in the cardiac reinnervation than the no cardiac reinnervation group. These results suggest that cardiac reinnervation associates with hemodynamic and cardiorespiratory adaptations to exercise training in individuals with heart transplantation.

Physical activity prevents blood pressure increases in individuals under treatment for knee osteoarthritis.

The aim of this study was to assess the role of physical activity in blood pressure (BP) in individuals with knee osteoarthritis. We compared 136 participants under treatment for primary knee osteoarthritis (age=67.6±9.6 years) allocated to the sedentary-sedentary, active-sedentary, sedentary-active, and active-active groups depending on their levels of daily physical activity before and after follow-up. Their BP, BMI, and endurance performance (6-min walking test) were compared during 12 months of follow-up. The sedentary-sedentary group had increased systolic BP (11±3 mmHg), and the active-sedentary group had increased systolic (12±4 mmHg) and diastolic BP (5±1 mmHg) during follow-up. By contrast, the sedentary-active group maintained systolic BP and showed reduced diastolic BP (5±2 mmHg), and the active-active group maintained both systolic and diastolic BP. Positive effects on BP were accompanied by improvements in endurance performance and BMI in the sedentary-active group (endurance performance=8.5±2.7%; BMI=9.3±3.6%) and the active-active group (endurance performance=2.9±0.9%; BMI=3.8±2.0%), which did not occur in the sedentary-sedentary and active-sedentary groups. These results suggest a positive role of high levels of daily living physical activity in the prevention/management of hypertension in individuals with knee osteoarthritis.

Heart rate response to exercise and cardiorespiratory fitness of young women at high familial risk for hypertension: effects of interval vs continuous training.

Exercise training is an effective intervention for treating and preventing hypertension, but its effects on heart rate (HR) response to exercise and cardiorespiratory fitness (CRF) of non-hypertensive offspring of hypertensive parents (FH+) has not been studied. We compared the effects of three times per week equal-volume high-intensity aerobic interval (AIT) and continuous moderate-intensity exercise (CME) on HR response to exercise and CRF of FH+. Forty-four young FH+ women (25.0 ± 4.4 years) randomized to control (CON; n = 12), AIT (80-90% of VO(2MAX); n = 16), or CME (50-60% of VO(2MAX); n = 16) performed a graded exercise test (GXT) before and after 16 weeks of follow-up to evaluate HR response to exercise and several parameters of CRF. Resting, maximal, and reserve HR did not change after the follow-up in all groups. HR recovery (difference between HR(MAX) and HR at 1 minute of GXT recovery phase) improved only after AIT (11.8 ± 4.9 vs. 20.6 ± 5.8 bpm, p < 0.01). Both exercise programmes were effective for improving CRF parameters, but AIT was more effective than CME for improving oxygen consumption at the respiratory compensation point (VO(2RCP); 22.1% vs. 8.8%, p = 0.008) and maximal effort (VO(2MAX); 15.8% vs. 8.0%, p = 0.036), as well as tolerance time (TT) to reach anaerobic threshold (TT(AT); 62.0 vs. 37.7, p = 0.048), TT(RCP) (49.3 vs. 32.9, p = 0.032), and TT(MAX) (38.9 vs. 29.2, p = 0.042). Exercise intensity was an important factor in improving HR recovery and CRF of FH+women. These findings may have important implications for designing exercise-training programmes for the prevention of an inherited hypertensive disorder.

Age does not affect exercise intensity progression among women.

It has been recommended that the intensity of exercise training (ET) should progress slowly with lower increments in older than in young people. However, scientific evidence supporting this recommendation is lacking. Our aim was to examine possible influences of age on exercise intensity progression in healthy women. Seventeen young (29.1 ± 5.7 years) and 16 older women (64.5 ± 4.5 years) underwent 13 weeks of ET consisting of cycle ergometry (CE, 65-75% of reserve heart rate), whole-body resistance exercise (RE, 60% of 1 repetition maximum [1RM]), and stretching. Muscle strength was assessed before and after ET by the 1RM. Cycle ergometry and RE workloads were recorded for each exercise session, and increases of 5-10% were made whenever adaptation occurred. Absolute muscle strength after ET improved (p < 0.001) in both groups, and there were no significant differences between groups. Relative exercise intensity progression was not significantly different between groups for RE (Pearson's correlation = 0.98 ± 0.01), but it was greater in older women for CE (p = 0.047). The ET was safe because no injuries or major muscle pain was observed in either group. These results suggest that healthy older women are capable of exercising and increasing exercise intensity in the same way as young women.

Effects of high-intensity aerobic interval training vs. moderate exercise on hemodynamic, metabolic and neuro-humoral abnormalities of young normotensive women at high familial risk for hypertension.

Exercise training has an important role in the prevention and treatment of hypertension, but its effects on the early metabolic and hemodynamic abnormalities observed in normotensive offspring of hypertensive parents (FH+) have not been studied. We compared high-intensity interval (aerobic interval training, AIT) and moderate-intensity continuous exercise training (CMT) with regard to hemodynamic, metabolic and hormonal variables in FH+ subjects. Forty-four healthy FH+ women (25.0+/-4.4 years) randomized to control (ConFH+) or to a three times per week equal-volume AIT (80-90% of VO(2MAX)) or CMT (50-60% of VO(2MAX)) regimen, and 15 healthy women with normotensive parents (ConFH-; 25.3+/-3.1 years) had their hemodynamic, metabolic and hormonal variables analyzed at baseline and after 16 weeks of follow-up. Ambulatorial blood pressure (ABP), glucose and cholesterol levels were similar among all groups, but the FH+ groups showed higher insulin, insulin sensitivity, carotid-femoral pulse wave velocity (PWV), norepinephrine and endothelin-1 (ET-1) levels and lower nitrite/nitrate (NOx) levels than ConFH- subjects. AIT and CMT were equally effective in improving ABP (P<0.05), insulin and insulin sensitivity (P<0.001); however, AIT was superior in improving cardiorespiratory fitness (15 vs. 8%; P<0.05), PWV (P<0.01), and BP, norepinephrine, ET-1 and NOx response to exercise (P<0.05). Exercise intensity was an important factor in improving cardiorespiratory fitness and reversing hemodynamic, metabolic and hormonal alterations involved in the pathophysiology of hypertension. These findings may have important implications for the exercise training programs used for the prevention of inherited hypertensive disorder.

Effect of exercise training on 24-hour ambulatory blood pressure monitoring in heart failure patients.

The aim of this study was to evaluate the 24-hour ambulatory blood pressure monitoring (ABPM) response to exercise training (ET) in heart failure (HF) patients. Twelve HF patients and 15 sedentary healthy controls underwent ET for 2 months (3 times per week from 80%-90% of the ventilatory threshold). ABPM was performed before and 2 days after the last exercise season. Despite the fact that ET in HF patients was associated with significant improvements in peak oxygen consumption (pVO2), there were no significant changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR). On the other hand, controls decreased 24-hour mean SBP (117+/-8-115+/-9 mm Hg, P=.019) and 24-hour mean DBP (73+/-6-71+/-5 mm Hg, P=.016), mainly at nighttime SBP (107+/-8-103+/-9, P=.0004) and DBP (63+/-5-59+/-5 mm Hg, P<.0001). No changes in HR were found in controls. Values of 24-hour blood pressure did not change with ET in HF patients.

Acute effects of continuous and interval aerobic exercise on 24-h ambulatory blood pressure in long-term treated hypertensive patients.

BACKGROUND: Despite antihypertensive therapy, it is difficult to maintain optimal systemic blood pressure (BP) values in hypertensive patients (HPT). Exercise may reduce BP in untreated HPT. However, evidence regarding its effect in long-term antihypertensive therapy is lacking. Our purpose was to evaluate the acute effects of 40-minute continuous (CE) or interval exercise (IE) using cycle ergometers on BP in long-term treated HPT. METHODS: Fifty-two treated HPT were randomized to CE (n=26) or IE (n=26) protocols. CE was performed at 60% of reserve heart rate (HR). IE alternated consecutively 2 min at 50% reserve HR with 1 min at 80%. Two 24-h ambulatory BP monitoring were made after exercise (postexercise) or a nonexercise control period (control) in random order. RESULTS: CE reduced mean 24-h systolic (S) BP (2.6+/-6.6 mm Hg, p=0.05) and diastolic (D) BP (2.3+/-4.6, p=0.01), and nighttime SBP (4.8+/-6.4, p<0.001) and DBP (4.6+/-5.2 mm Hg, p=0.001). IE reduced 24-h SBP (2.8+/-6.5, p=0.03) and nighttime SBP (3.4+/-7.2, p=0.02), and tended to reduce nighttime DBP (p=0.06). Greater reductions occurred in higher BP levels. Percentage of normal ambulatory BP values increased after CE (24-h: 42% to 54%; daytime: 42% to 61%; nighttime: 61% to 69%) and IE (24-h: 31% to 46%; daytime: 54% to 61%; nighttime: 46% to 69%). CONCLUSION: CE and IE reduced ambulatory BP in treated HPT, increasing the number of patients reaching normal ambulatory BP values. These effects suggest that continuous and interval aerobic exercise may have a role in BP management in treated HPT.

Acute aerobic exercise reduces 24-h ambulatory blood pressure levels in long-term-treated hypertensive patients.

BACKGROUND: Even with anti-hypertensive therapy, it is difficult to maintain optimal systemic blood pressure values in hypertensive patients. Exercise may reduce blood pressure in untreated hypertensive, but its effect when combined with long-term anti-hypertensive therapy remains unclear. Our purpose was to evaluate the acute effects of a single session of aerobic exercise on the blood pressure of long-term-treated hypertensive patients. METHODS: Fifty treated hypertensive patients (18/32 male/female; 46.5+/-8.2 years; Body mass index: 27.8+/-4.7 kg/m(2)) were monitored for 24 h with respect to ambulatory (A) blood pressure after an aerobic exercise session (post-exercise) and a control period (control) in random order. Aerobic exercise consisted of 40 minutes on a cycle-ergometer, with the mean exercise intensity at 60% of the patient's reserve heart rate. RESULTS: Post-exercise ambulatory blood pressure was reduced for 24 h systolic (126+/-8.6 vs. 123.1+/-8.7 mmHg, p=0.004) and diastolic blood pressure (81.9+/-8 vs. 79.8+/-8.5 mmHg, p=0.004), daytime diastolic blood pressure (85.5+/-8.5 vs. 83.9+/-8.8 mmHg, p=0.04), and nighttime S (116.8+/-9.9 vs. 112.5+/-9.2 mmHg, p<0.001) and diastolic blood pressure (73.5+/-8.8 vs. 70.1+/-8.4 mmHg, p<0.001). Post-exercise daytime systolic blood pressure also tended to be reduced (129.8+/-9.3 vs. 127.8+/-9.4 mmHg, p=0.06). These post-exercise decreases in ambulatory blood pressure increased the percentage of patients displaying normal 24h systolic blood pressure (58% vs. 76%, p=0.007), daytime systolic blood pressure (68% vs. 82%, p=0.02), and nighttime diastolic blood pressure (56% vs. 72%, p=0.02). Nighttime systolic blood pressure also tended to increase (58% vs. 80%, p=0.058). CONCLUSION: A single bout of aerobic exercise reduced 24h ambulatory blood pressure levels in long-term-treated hypertensive patients and increased the percentage of patients reaching normal ambulatory blood pressure values. These effects suggest that aerobic exercise may have a potential role in blood pressure management of long-term-treated hypertensive.

Acute aerobic exercise reduces 24-h ambulatory blood pressure levels in long-term-treated hypertensive patients

BACKGROUND: Even with anti-hypertensive therapy, it is difficult to maintain optimal systemic blood pressure values in hypertensive patients. Exercise may reduce blood pressure in untreated hypertensive, but its effect when combined with long-term anti-hypertensive therapy remains unclear. Our purpose was to evaluate the acute effects of a single session of aerobic exercise on the blood pressure of long-term-treated hypertensive patients. METHODS: Fifty treated hypertensive patients (18/32 male/female; 46.5±8.2 years; Body mass index: 27.8±4.7 kg/m²) were monitored for 24 h with respect to ambulatory (A) blood pressure after an aerobic exercise session (post-exercise) and a control period (control) in random order. Aerobic exercise consisted of 40 minutes on a cycle-ergometer, with the mean exercise intensity at 60 percent of the patient's reserve heart rate. RESULTS: Post-exercise ambulatory blood pressure was reduced for 24 h systolic (126±8.6 vs. 123.1±8.7 mmHg, p=0.004) and diastolic blood pressure (81.9±8 vs. 79.8±8.5 mmHg, p=0.004), daytime diastolic blood pressure (85.5±8.5 vs. 83.9±8.8 mmHg, p=0.04), and nighttime S (116.8±9.9 vs. 112.5±9.2 mmHg, p<0.001) and diastolic blood pressure (73.5±8.8 vs. 70.1±8.4 mmHg, p<0.001). Post-exercise daytime systolic blood pressure also tended to be reduced (129.8±9.3 vs. 127.8±9.4 mmHg, p=0.06). These post-exercise decreases in ambulatory blood pressure increased the percentage of patients displaying normal 24h systolic blood pressure (58 percent vs. 76 percent, p=0.007), daytime systolic blood pressure (68 percent vs. 82 percent, p=0.02), and nighttime diastolic blood pressure (56 percent vs. 72 percent, p=0.02). Nighttime systolic blood pressure also tended to increase (58 percent vs. 80 percent, p=0.058). CONCLUSION: A single bout of aerobic exercise reduced 24h ambulatory blood pressure levels in long-term-treated hypertensive patients and increased the percentage of patients reaching normal...