Role of sex and training characteristics on exercise effects on cardiovascular aging: protocol for a systematic review with meta-analysis of randomized trials.

BACKGROUND: Cardiovascular diseases remain a leading global cause of mortality worldwide especially in older adults. Although it is known that regular exercise reduces cardiovascular diseases incidence, its effects on specific cardiovascular aging parameters considering the influence of sex and different exercise designs are still not fully understood. Therefore, this systematic review and meta-analysis aims to evaluate the effects of different physical exercise protocols on age-related cardiovascular outcomes in older adults. METHODS: This systematic review and meta-analysis will be reported in agreement with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Articles will be eligible if they are randomized controlled trials with a primary objective of evaluating the chronic effects of exercise interventions on cardiovascular aging parameters. Search strategy will be performed from the inception to September 30th, 2023, in the following electronic databases: MEDLINE (Ovid), SCOPUS (Elsevier), Embase, Sport Discus (EBSCO), Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science Core Collection (Clarivate Analytics). Data will be extracted and managed through Research Electronic Data Capture (REDCap) software. The Tool for the assEssment of Study qualiTy and reporting in EXercise (TESTEX) will be used to assess the methodological quality of included studies. Additionally, the quality of the findings will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) profiler. Meta-analysis based on the random-effects model will be performed (if deemed suitable, considering the methodological and clinical heterogeneity of the studies) to estimate the effects of exercise training on cardiovascular aging variables (i.e., cardiac output; arterial stiffness; stroke volume; endothelial function; and carotid intima-media thickness). Heterogeneity will be assessed with the I2 statistics, while the publication bias will be assessed based on Egger's test. DISCUSSION: To the best of our knowledge, this will be the first systematic review and meta-analysis to investigate the impact of sex and training protocols on the cardiovascular aging parameters. Moreover, the findings of this systematic review and meta-analysis will provide evidence for health professionals in the management of elderly patients in order to optimize the exercise prescription to face the cardiovascular alterations related to the aging process, considering the effects of different protocols according to sex. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42023441015 .

Characterizing the interindividual postexercise hypotension response for two order groups of concurrent training in patients with morbid obesity.

Background: Postexercise hypotension (PEH) is a common physiological phenomenon occurring immediately after endurance training (ET), resistance training (RT), and ET plus RT, also termed concurrent training (CT); however, there is little knowledge about the interindividual and magnitude response of PEH in morbidly obese patients. Aim: The aims of this study were (1) to investigate the effect of CT order (ET + RT vs. RT + ET) on the blood pressure responses; 2) characterize these responses in responders and nonresponders, and 3) identify potential baseline outcomes for predicting blood pressure decreases as responders. Methods: A quasi-experimental study developed in sedentary morbidly obese men and women (age 43.6 ± 11.3 years; body mass index [BMI] ≥40 kg/m2) was assigned to a CT group of ET plus RT (ET + RT; n = 19; BMI 47.8 ± 16.7) or RT plus ET order group (RT + ET; n = 17; BMI 43.0 ± 8.0). Subjects of both groups received eight exercise sessions over four weeks. Primary outcomes include systolic (SBP), diastolic (DBP), mean arterial pressure [MAP], heart rate at rest [HR], and pulse pressure [PP] measurements before and after 10 min post-exercise. Secondary outcomes were other anthropometric, body composition, metabolic, and physical fitness parameters. Using the delta ∆SBP reduction, quartile categorization (Q) in "high" (Rs: quartile 4), "moderate" (MRs: quartile 3), "low" (LRs: quartile 2), and "nonresponders" (NRs: quartile 1) was reported. Results: Significant pre-post changes were observed in ET + RT in session 2 for SBP (131.6 vs. 123.4 mmHg, p = 0.050) and session 4 (131.1 vs. 125.2 mmHg, p = 0.0002), while the RT + ET group showed significant reductions in session 4 (134.2 vs. 125.3 mmHg, p < 0.001). No significant differences were detected in the sum of the eight sessions for SBP (∑∆SBP) between ET + RT vs. RT + ET (-5.7 vs. -4.3 mmHg, p = 0.552). Interindividual analyses revealed significant differences among frequencies comparing Q1 "NRs" (n = 8; 22.2%), Q2 "LRs" (n = 8; 22.2%), Q3 "MRs" (n = 9; 25.0%), and Q4 "HRs" (n = 11; 30.5%), p < 0.0001. Quartile comparisons showed significant differences in SBP changes (p = 0.035). Linear regression analyses revealed significant association between ∑∆SBP with body fat % (ß -3.826, R 2 0.211 [21.1%], p = 0.031), skeletal muscle mass [ß -2.150, R 2 0.125 (12.5%), p = 0.023], fasting glucose [ß 1.273, R 2 0.078 (7.8%), p = 0.003], triglycerides [ß 0.210, R 2 0.014 (1.4%), p = 0.008], and the 6-min walking test [ß 0.183, R 2 0.038 (3.8%), p = 0.044]. Conclusion: The CT order of ET + RT and RT + ET promote a similar 'magnitude' in the postexercise hypotensive effects during the eight sessions of both CT orders in 4 weeks of training duration, revealing "nonresponders" and 'high' responders that can be predicted from body composition, metabolic, and physical fitness outcomes.

Cardiovascular, Respiratory, and Functional Effects of Home-Based Exercise Training after COVID-19 Hospitalization.

INTRODUCTION: The present randomized, single-center, and single-blinded clinical trial tested the hypothesis that tele-supervised home-based exercise training (exercise) is an effective strategy for improving cardiovascular, respiratory, and functional capacity parameters in individuals who were hospitalized due to coronavirus disease 2019 (COVID-19). METHODS: Thirty-two individuals (52 ± 10 yr; 17 were female) randomly assigned to exercise ( n = 12) or control groups ( n = 20) had their anthropometric (weight, body mass index), hemodynamic (brachial and central blood pressure), vascular (arterial stiffness), ventilatory (pulmonary function and respiratory muscle strength), and functional parameters (handgrip strength, five-time sit to stand, timed up and go test, and 6-min walking test) assessed at baseline (30-45 d of hospital discharged) and after 12 wk of follow-up. RESULTS: Both groups similarly increased ( P < 0.001) forced vital capacity (absolute and percent of predicted), forced expiratory volume in the first second (absolute and percent of predicted), and handgrip strength during follow-up. However, only the exercise group reduced carotid-femoral pulse wave velocity (-2.0 ± 0.6 m·s -1 , P = 0.048) and increased ( P < 0.05) resting oxygen saturation (1.9% ± 0.6%), mean inspiratory pressure (24.7 ± 7.1 cm H 2 O), mean expiratory pressure (20.3 ± 5.8 cm H 2 O), and percent of predicted mean expiratory pressure (14% ± 22%) during follow-up. No significant changes were found in any other variable during follow-up. CONCLUSIONS: Present findings suggest that tele-supervised home-based exercise training can be a potential adjunct therapeutic to rehabilitate individuals who were hospitalized due to COVID-19.

Can Previous Levels of Physical Activity Affect Risk Factors for Cardiorespiratory Diseases and Functional Capacity after COVID-19 Hospitalization? A Prospective Cohort Study.

Purpose: To evaluate the influence of previous levels of physical activity on hemodynamic, vascular, ventilatory, and functional outcomes after coronavirus disease 2019 (COVID-19) hospitalization. Methods: Sixty-three individuals with COVID-19 had their clinical status and previous levels (12 month) of physical activity (Baecke Questionnaire of Habitual Physical Activity) assessed at hospital admission. Individuals were then allocated to lower levels of physical activity (ACTLOWER; N = 22), intermediate levels of physical activity (ACTINTERMEDIATE; N = 22), or higher levels of physical activity (ACTHIGHER; N = 19) groups, according to tertiles of physical activity. Resting hemodynamic (heart rate and brachial/central blood pressures) and vascular (carotid-femoral pulse wave velocity, augmentation index, and brachial artery flow-mediated dilation) variables, pulmonary function (spirometry), respiratory muscle strength (maximal respiratory pressures), and functional capacity (handgrip strength, five-time sit-to-stand, timed-up and go, and six-minute walking tests) were measured at 30 to 45 days after hospital discharge. Results: ACTLOWER showed lower levels (P < 0.05) of forced vital capacity, forced expiratory volume in the first second, maximal voluntary ventilation, and maximal expiratory pressure than ACTHIGHER. ACTLOWER also had lower (P = 0.023) walking distance (~21%,) and lower percentage of predicted walking distance (~20%) at six-minute walking test during follow-up than ACTINTERMEDIATE. However, hemodynamic and vascular variables, handgrip strength, five-time sit-to-stand, and timed-up and go were not different among groups. Conclusion: ACTLOWER showed impaired ventilatory parameters and walking performance when compared with ACTHIGHER and ACTINTERMEDIATE, respectively. These results suggest that previous levels of physical activity may impact ventilatory and exercise capacity outcomes 30 to 45 days after COVID-19 hospitalization discharge.

Determinants of endothelial dysfunction in noncritically ill hospitalized COVID-19 patients: A cross-sectional study.

OBJECTIVE: The aim of this study was to identify determinants of endothelial dysfunction in patients hospitalized with acute COVID-19. METHODS: A total of 109 hospitalized COVID-19 patients in noncritical status were cross-sectionally studied. Clinical data (age, sex, comorbidities, and medications) and BMI were assessed. Laboratory tests included serum hemoglobin, leukocytes, lymphocytes, platelets, C-reactive protein, ferritin, D-dimer, and creatinine. Physical status was evaluated using a handgrip dynamometer. Endothelial function was assessed noninvasively using the flow-mediated dilation (FMD) method. RESULTS: The sample average age was 51 years, 51% of patients were male, and the most frequent comorbidity was obesity (62%). Univariate analysis showed association of lower FMD with higher BMI, hypertension, use of oral antihypertensive, higher blood levels of creatinine, and larger baseline artery diameter. After adjusting for confounders, the multivariate analysis showed BMI (95% CI: -0.26 to -0.11; p < 0.001) as the major factor associated with FMD. Other factors associated with FMD were baseline artery diameter (95% CI: -1.77 to -0.29; p = 0.007) and blood levels of creatinine (95% CI: -1.99 to -0.16; p = 0.022). CONCLUSIONS: Increased BMI was the major factor associated with endothelial dysfunction in noncritically hospitalized COVID-19 patients. This may explain one of the pathways in which obesity may increase the risk for severe COVID-19.

Prescribing and Self-Regulating Heated Water-Based Exercise by Rating of Perceived Exertion in Older Individuals With Hypertension.

We aimed to analyze the usefulness of the 6-20 rating of perceived exertion (RPE) scale for prescribing and self-regulating high-intensity interval (HIIE) and moderate-intensity continuous (MICE) aerobic exercise performed in a heated swimming pool (32 °C). Fifteen older individuals (65 ± 3 years) treated for hypertension underwent a symptom-limited maximal graded exercise test to determine their heart rate at anaerobic threshold, and respiratory compensation point. On different days, participants were randomized to HIIE (walking/jogging between 11 and 17 of RPE; 25 min) and MICE (walking at 11-13 of RPE; 30 min). Heart rate during the low-intensity intervals of HIIE and MICE remained below the graded exercise test's heart rate at anaerobic threshold (-7 ± 18 bpm/-16 ± 15 bpm) and respiratory compensation point (-18 ± 18 bpm/-30 ± 16 bpm), respectively, and maintained in the aerobic training zone during the high-intensity intervals of HIIE (+8 ± 18 bpm/-4 ± 19 bpm). The RPE scale at 15-17 is a useful tool for prescribing and self-regulating heated water-based HIIE and may have important implications for water-based exercise in older individuals with hypertension.

Residual Impact of Concurrent, Resistance, and High-Intensity Interval Training on Fasting Measures of Glucose Metabolism in Women With Insulin Resistance.

We sought to assess the residual effects (post 72-h training cessation) on fasting plasma glucose (FPG) and fasting insulin (FI) after 12-weeks of high-intensity interval training (HIIT), resistance training (RT), or concurrent training (CT) in women with insulin resistance (IR). We also aimed to determine the training-induced, post-training residual impact of CT. A total of adult 45 women (age 38.5±9.2years) were included in the final analysis and were assigned to a control (CG; n=13, BMI 28.3±3.6kg/m2), HIIT [n=14, BMI 28.6±3.6kg/m2, three sessions/wk., 80-100% of the maximum heart rate (HRmax)], RT [n=8, BMI 29.4±5.5kg/m2, two sessions/wk., 8-10 points of the modified Borg, corresponding to 20 to 50% range of one maximum repetition test (1RM)], or CT group (n=10, BMI 29.1±3.0kg/m2, three sessions/wk., 80-100% of HRmax, and 8-10 Borg, or 20 to 50% range of 1RM, to each HIIT and RT compounds), with the latter including both HIIT and RT regimens. Training interventions lasted 12-weeks. The main outcomes were FPG and FI measured at pre- and 24-h and 72-h post-training (FPG24h, FI24h, and FPG72h, FI72h, respectively). Secondary endpoints were body composition/anthropometry and the adiposity markers waist circumference (WC) and tricípital skinfold (TSF). The residual effects 72-h post-training [delta (∆)] were significantly poorer (all p<0.01) in the CT group (∆FPG72h+6.6mg/dl, η 2: 0.76) than in the HIIT (∆FPG72h+1.2mg/dl, η 2: 0.07) and RT (∆FPG72h+1.0mg/dl, η 2: 0.05) groups. These findings reveal that HIIT reduces FPG and RT reduces FI 24-h post-training; both exercise interventions alone have remarkably better residual effects on FPG and FI (post-72h) than CT in women with insulin resistance.

Short-term community-based exercise programs in low-income older women: Does exercise intensity and modality matters?

Our aim was to evaluate the effect of community-based exercise program (CBEP) intensity and modality on anthropometric, hemodynamic, and functional capacity parameters in low-income older women. Forty insufficiently active older women (68.2 ± 7.9 years) were randomly assigned to perform 12 weeks of twice-weekly high-intensity interval training combined with resistance training (HIIT+RT/n = 12), moderate-intensity continuous training combined with resistance training (MICT+RT/n = 13), or resistance training alone (RT/n = 15). Anthropometric (body mass index and waist circumference), hemodynamic (blood pressure and heart rate), and functional capacity variables (flexibility, upper and lower limb muscle strength, and mobility) were assessed before and after training programs. Waist circumference reduced similarly after all CBEP (~3 to ~4 cm; P < 0.05). Tendency toward reduction in diastolic blood pressure (~4 mm Hg; P = 0.073), and improvements in flexibility (14.5%, P = 0.011) and handgrip strength (15.8%; P = 0.02) were found only in HIIT+RT. Indeed, only RT was effective to improve five-time sit to stand (14.1%; P = 0.013). No significant difference between groups was found during follow-up in any variable. The results of present study suggest that low-income older women may improve anthropometric, hemodynamic and functional capacity variables by participating in twice-weekly short-term (i.e.: 12 weeks) CBEP. However, the CBEP-effects on hemodynamic and functional capacity appears to be affected by exercise intensity (only HIIT+RT tended toward improving diastolic BP) and modality (only RT improved significantly five-time sit to stand), respectively.

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.

Post-exercise Hypotension Following a Single Bout of High Intensity Interval Exercise vs. a Single Bout of Moderate Intensity Continuous Exercise in Adults With or Without Hypertension: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

Background: Post-exercise hypotension (PEH) is an important tool in the daily management of patients with hypertension. Varying the exercise parameters is likely to change the blood pressure (BP) response following a bout of exercise. In recent years, high-intensity interval exercise (HIIE) has gained significant popularity in exercise-based prevention and rehabilitation of clinical populations. Yet, to date, it is not known whether a single session of HIIE maximizes PEH more than a bout of moderate-intensity continuous exercise (MICE). Objective: To compare the effect of HIIE vs. MICE on PEH by means of a systematic review and meta-analysis. Methods: A systematic search in the electronic databases MEDLINE, Embase, and SPORTDiscus was conducted from the earliest date available until February 24, 2020. Randomized clinical trials comparing the transient effect of a single bout of HIIE to MICE on office and/or ambulatory BP in humans (≥18 years) were included. Data were pooled using random effects models with summary data reported as weighted means and 95% confidence interval (CIs). Results: Data from 14 trials were included, involving 18 comparisons between HIIE and MICE and 276 (193 males) participants. The immediate effects, measured as office BP at 30- and 60-min post-exercise, was similar for a bout of HIIE and MICE (p > 0.05 for systolic and diastolic BP). However, HIIE elicited a more pronounced BP reduction than MICE [(-5.3 mmHg (-7.3 to -3.3)/ -1.63 mmHg (-3.00 to -0.26)] during the subsequent hours of ambulatory daytime monitoring. No differences were observed for ambulatory nighttime BP (p > 0.05). Conclusion: HIIE promoted a larger PEH than MICE on ambulatory daytime BP. However, the number of studies was low, patients were mostly young to middle-aged individuals, and only a few studies included patients with hypertension. Therefore, there is a need for studies that involve older individuals with hypertension and use ambulatory BP monitoring to confirm HIIE's superiority as a safe BP lowering intervention in today's clinical practice. Systematic Review Registration: PROSPERO (registration number: CRD42020171640).

The Urgent Need for Recommending Physical Activity for the Management of Diabetes During and Beyond COVID-19 Outbreak.

Diabetes is the second most prevalent non-communicable chronic diseases (NCDs) in patients with coronavirus disease 2019 (COVID-19) and is highly associated with increased incidence of disease severity and mortality. Individuals with diabetes and poor glycemic control have an even worse prognosis. Despite of the need/effectiveness of social distancing measures (i.e.: home confinement, quarantine and/or lockdown) during COVID-19 outbreak, preliminary findings showed an increase in negative behaviors during COVID-19 home confinement (i.e.: ~33.5% reduction in physical activity, ~28.6% (~3.10h) increase in sedentary behavior (i.e.: daily sitting, reclining and lying down time), and more unhealthy food consumption and meal pattern), which may have important clinical implications. For example, we estimated that this reduction in physical activity can increase the cases of type 2 diabetes (from ~7.2% to ~9.6%; ~11.1 million cases per year) and all-cause mortality (from ~9.4% to ~12.5%; ~1.7 million deaths per year) worldwide. Few weeks of reduction in physical activity levels result in deleterious effects on several cardiometabolic (i.e.: glycemic control, body composition, inflammatory cytokines, blood pressure, vascular function…) and functional parameters (i.e.: cardiorespiratory/muscle fitness, balance, agility…). In contrast, physical activity and exercise are important tools for preventing and treating diabetes and others NCDs. Home-based exercise programs are useful, safe and effective for the management of diabetes, and could be widely used during COVID-19 outbreak. In this context, there is an urgent need for recommending physical activity/exercise, during and beyond COVID-19 outbreak, for improving the management of diabetes, as well as to prevent the increase in global burden of COVID-19, diabetes and others NCDs.

Hypotensive Effect of Heated Water-based Exercise in Older Individuals with Hypertension.

Blood pressure (BP) and hemodynamic response to heated water-based (HEx) vs. land-based exercise (LEx) were assessed in 15 (6 men) older hypertensives (age 66.4±4.9 yr) under pharmacological treatment. Participants were randomly assigned to perform 30 min of moderate-intensity HEx (walking inside the pool), LEx (walking on a treadmill) and non-exercise control (CON) intervention. Resting BP, arterial stiffness, endothelial reactivity and heart rate variability (HRV) were measured before, immediately after, and 45 min after interventions. 24-h ambulatory BP monitoring was performed after interventions. Resting systolic (but not diastolic) BP reduced 9.9±3.1 mmHg (P<0.01) 45 min after HEx only. 24-h systolic and diastolic, daytime diastolic and nightime systolic BP were lower (P<0.05) after HEx than both LEx and CON. Daytime systolic BP was also lower (P<0.05) after HEx than CON. Nighttime diastolic was not different between interventions. HEx-induced ambulatory BP reduction ranged 4.5±1.3 mmHg (24-h diastolic BP) to 9.5±3.0 mmHg (nighttime systolic BP), and persisted for 18/11 h in systolic/diastolic BP, when compared with CON. No significant changes in arterial stiffness, endothelial reactivity and HRV were found during any intervention. These results suggest that HEx may have important implications for managing BP in older hypertensive under pharmacological treatment.

Prescribing high-intensity interval exercise by RPE in individuals with type 2 diabetes: metabolic and hemodynamic responses.

We tested the hypothesis that rating of perceived exertion (RPE) is a tool as efficient as the heart rate (HR) response to the cardiopulmonary exercise test (CPX) for prescribing and self-regulating high-intensity interval exercise (HIIE), and that metabolic and hemodynamic response to HIIE is superior than to continuous moderate-intensity exercise (MICE) in individuals with type 2 diabetes mellitus (T2DM). Eleven participants (age = 52.3 ± 3 years) underwent HIIE prescribed and self-regulated by RPE (HIIERPE; 25 min), HIIE prescribed and regulated by an individual's HR response to CPX (HIIEHR; 25 min), MICE prescribed and self-regulated by RPE (30 min) and control (30 min of seated resting) intervention in random order. HR, blood pressure (BP), capillary glucose, endothelial reactivity, and carotid-femoral pulse wave velocity were assessed before, immediately after, and 45 min after each intervention. Exercise HR, speed, and distance were measured during exercise sessions. Twenty-four-hour ambulatory BP was measured after each intervention. Exercise HR, speed, and distance were similar between HIIERPE and HIIEHR. BP response was not different among HIIERPE, HIIEHR, and MICE. Capillary glycaemia reduction was greater (P < 0.05) after HIIERPE (48.6 ± 9.6 mg/dL) and HIIEHR (47.2 ± 9.5 mg/dL) than MICE (29.5 ± 11.5 mg/dL). Reduction (P < 0.05) in 24-h (6.7 ± 2.2 mm Hg) and tendency toward reduction (P = 0.06) in daytime systolic (7.0 ± 2.5 mm Hg) ambulatory BP were found only after HIIERPE. These results suggest that HIIE is superior to MICE for reducing glycaemia and ambulatory BP, and that the 6-20 RPE scale is a useful tool for prescribing and self-regulating HIIE in individuals with T2DM.

High-Intensity Interval Training as a Tool for Counteracting Dyslipidemia in Women.

Sedentary overweight or obese adult (age<60 years) women, allocated in type 2 diabetes mellitus (T2DM, n=13), dyslipidemia alone (DYS, n=12), dyslipidemia associated with hyperglycaemia (DYSHG, N=12), or healthy control (CON, n=10) groups, had their lipid, glucose, blood pressure, endurance performance, and anthropometry variables assessed before and after 16 weeks of a thrice-weekly high-intensity interval training (HIIT) program. Triglycerides reduced significantly (P<0.05) in all groups, and high-density lipoprotein increased (P<0.01) in T2DM, DYS and DYSHG; however, low-density lipoprotein reduced (P<0.05) only in DYSHG, and total cholesterol reduced (P<0.01) only in DYS and DYSHG. Fasting glucose reduced (P<0.05) significantly in T2DM, DYS and DYSHG, but with higher decreases in T2DM and DYSHG. Blood pressure, endurance performance and body composition improved (P<0.05) in all groups. The HIIT program was effective for restoring lipid profile of DYS and DYSHG, and fasting glucose of DYSHG to levels similar to those of CON, with a weekly time commitment 25% to 56% lower than the minimum recommended in current exercise guidelines. These findings suggest that HIIT may be a time-efficient intervention for counteracting dyslipidemia.

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.

Educational program promoting regular physical exercise improves functional capacity and daily living physical activity in subjects with knee osteoarthritis.

BACKGROUND: Physical exercise and educational programs promote several benefits for patients with knee osteoarthritis (OA). However, little is known about the effects of educational programs promoting the regular practice of physical exercise. The purpose of the present study was to assess the effect of an interdisciplinary educational program, emphasizing the recommendation for regular practice of physical exercise, on functional capacity and daily living physical activity in individuals with knee OA. METHODS: Two hundred and thirty-nine individuals (50 men) with an established diagnosis of knee OA (degree I to IV in the Kelgreen and Lawrence scale) were randomly allocated into a multidisciplinary educational program (EDU; n = 112) or control group (CON; n = 127). Functional capacity (sit and reach, 6-min walking test (6MWT), timed up and down stairs test, timed up and go test (TUGT), and five times sit-to-stand test (FTSST)) and daily living physical activity (IPAQ, short version) were measured before, during (6 months) and after 12 months of follow-up. RESULTS: Body mass index reduced significantly (P < 0.05) after 6 months, and remained reduced after 12-month of follow-up in EDU, but not in CON. EDU group improved (P < 0.05) timed up and down stairs (19%), TUGT (32.5%) and FTSST (30%) performance after 6 months of follow-up, which remained improved after 12 months of follow-up. Functional capacity did not change in CON, excepted for the timed up and down stairs performance that increased after 6 months (12%, P < 0.05), but returned to levels similar to baseline after 12 months of follow-up. There was also an increase (P < 0.05) in the prevalence of active and very active individuals, as well as a reduction (P < 0.05) in the prevalence of sedentary individuals in EDU group during follow-up. There were no significant changes on sit and reach and 6MWT performance during follow-up in both groups. CONCLUSIONS: The results suggest that an educational program emphasizing the recommendation for regular practice of physical exercise may be an effective tool for improving functional capacity and daily physical activity in individuals with knee OA. TRIAL REGISTRATION: NCT 02335034 , December 22, 2014.

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.

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.