Use of Inter-Effort Recovery Hypoxia as a New Approach to Improve Anaerobic Capacity and Time to Exhaustion.

Putti, Germano Marcolino, Gabriel Peinado Costa, Matheus Silva Norberto, Carlos Dellavechia de Carvalho, Rômulo Cássio de Moraes Bertuzzi, and Marcelo Papoti. Use of inter-effort recovery hypoxia as a new approach to improve anaerobic capacity and time to exhaustion. High Alt Med Biol. 25:68-76, 2024. Background: Although adding hypoxia to high-intensity training may offer some benefits, a significant problem of this training model is the diminished quality of the training session when performing efforts in hypoxia. The purpose of this study was to investigate the effects of training and tapering combined with inter-effort recovery hypoxia (IEH) on anaerobic capacity, as estimated by alternative maximum accumulated oxygen deficit (MAODALT) and time to exhaustion (TTE). Methods: Twenty-four amateur runners performed, for 5 weeks, 3 sessions per week of training consisted of ten 1-minute bouts at 120% (weeks 1-3) and 130% (weeks 4 and 5) of maximum velocity (VMAX) obtained in graded exercise test, separated by a 2-minute interval in IEH (IEH, n = 11, FIO2 = 0.136) or normoxia (NOR, n = 13, fraction of inspired oxygen = 0.209). Before training, after training, and after 1 week of tapering, a graded exercise test and a maximal effort to exhaustion at 120% of VMAX were performed to determine TTE and MAODALT. The results were analyzed using generalized linear mixed models, and a clinical analysis was also realized by the smallest worthwhile change. Results: MAODALT increased only in IEH after training (0.8 ± 0.5 eq.lO2) and tapering (0.8 ± 0.5 eq.lO2), with time x group interaction. TTE increased for the pooled groups after taper (23 ± 11 seconds) and only for IEH alone (29 ± 16 seconds). Clinical analysis revealed a small size increase for NOR and a moderate size increase for IEH. Conclusions: Although the effects should be investigated in other populations, it can be concluded that IEH is a promising model for improving anaerobic performance and capacity. World Health Organization Universal Trial Number: U1111-1295-9954. University's ethics committee registration number: CAAE: 32220020.0.0000.5659.

Effects of Different Protocols of Moderate-Intensity Intermittent Hypoxic Training on Mental Health and Quality of Life in Brazilian Adults Recovered from COVID-19: The AEROBICOVID Double-Blind Randomized Controlled Study.

The aim of this study was to investigate the effects of different protocols of moderate-intensity intermittent hypoxic training in patients who had recovered from COVID-19 on quality of life (QoL) and mental health. The sample of this clinical trial-controlled double-blind study consisted of 67 participants aged 30-69 years, who were organized randomly according to Normoxia, Hypoxia, Hypoxia Recovery or Control Group. Eight weeks of cycle ergometer training were performed with a frequency of three training sessions per week in normoxic or hypoxic conditions (with or without hypoxic recovery). Health-related QoL and Mental Health Status were evaluated by 12-Item Short Form Survey and Depression Anxiety and Stress Scale instruments, respectively. All training groups improved the QoL's physical dimensions (Baseline-Post: Normoxia Group 42.1 (11.0)-48.7 (7.0), Hypoxia Group 46.9 (11.8)-53.5 (6.6) and Hypoxia Recovery Group 45.8 (9.2)-51.1 (5.3)) and mental dimensions (Baseline-Post: Normoxia Group 48.8 (7.9)-54.6 (4.6), Hypoxia Group 45.2 (7.7)-53.2 (3.8) and Hypoxia Recovery Group 46.5 (9.7)-52.0 (9.9)). Regarding mental health outcomes, all training groups decreased depressive symptoms (66.7% Normoxia, 31.2% Hypoxia Recovery and 31% Hypoxia groups), anxiety symptoms (46.5% Normoxia, 45.9% Hypoxia Recovery and 39.5% in the Hypoxia groups) and stress symptoms (40.6% Normoxia, 36.3% Hypoxia Recovery and 22.1% Hypoxia groups). Significant statistical difference was not found between groups. Normoxic and hypoxic training showed a similar effect on QoL and the mental health of Brazilian adults who had recovered from COVID-19.

Physical activity, depression, anxiety, and stress in adults and elderly in the COVID-19 pandemic in Brazil / Atividade física, depressão, ansiedade e estresse em adultos e idosos na pandemia COVID-19 no Brasil

The aim was to verify whether there is a relationship between physical activity habits and the indica-tion of associated risk for depression, anxiety, and stress in adults and the elderly during a period of the COVID-19 pandemic in Brazil. A cross-sectional study, with data collection between October and November 2021, was carried out using an online form, with questions about sociodemographic data, physical activity practice before and during the pandemic, health status, mental health through the Scale of Depression, Anxiety, and Stress (DASS-21), and level of physical activity through the International Physical Activity Questionnaire (IPAQ). Statistical analysis was performed using the chi-square test with a significance level of 5% and multiple correspondence analysis. The were 1044 men and women, aged between 18 and 75, from all over the national territory. Among them, 48.0%, 35.9%, and 61.1% showed an indication of associated risk for depression, anxiety, and stress, respec-tively. Adult participants 93.4%, female 66.8%, educational level up to undergraduate studies 54.2%, and single 57.5%, as well as those with a low level of physical activity 36.1% and who reported wors-ening in practice during the pandemic 53.9%, showed a greater risk indication for depression, anxiety and stress (p<0.05). In summary, physically active people who managed to maintain or improve their practice during the pandemic showed a lower indication of associated risk for problems related to mental health. It is important to consider the planning of public policies from the perspective of equity to help people with greater vulnerability in accessing physical activity

O objetivo foi verificar se há relação entre os níveis de atividade física e a indicação de risco associado para depressão, ansiedade e estresse em adultos e idosos durante um período da pandemia da COVID-19 no Brasil. Estudo transversal, entre outubro e novembro de 2021, foi realizado por meio de um formulário online, com perguntas sobre dados sociodemográficos, prática de atividade física antes e durante a pandemia, estado de saúde, saúde mental - Escala de Depressão, Ansiedade e Estresse (DASS-21) e nível de atividade física - Questionário Internacional de Atividade Física (IPAQ). A análise estatística foi realizada por meio do teste Qui-Quadrado com nível de significância de 5% e análise de correspondência múltipla. Participaram 1044 homens e mulheres, com idade entre 18 e 75 anos, de todo território nacional. Entre os participantes, 48,0%, 35,9% e 61,1% apresentaram indicação de risco associado para depressão, ansiedade e estresse, res-pectivamente. Os participantes adultos 93,4%, do gênero feminino 66,8%, nível de escolaridade até o ensino superior 54,2% e solteiros 57,5%, bem como os com nível baixo de atividade física 36,1% e que relataram piora na prática durante a pandemia 53,9% apresentaram maior indicação de risco para depressão, ansieda-de e estresse (p<0,05). Em síntese, pessoas fisicamente ativas e que conseguiram manter ou melhorar a prática durante a pandemia, apresentaram menor indicação de risco associado para problemas relacionados à saúde mental. É importante considerar o planejamento de políticas públicas sob a ótica da equidade, para auxiliar pessoas com maior vulnerabilidade no acesso à atividade física

Effects of Moderate-Intensity Training Under Cyclic Hypoxia on Cardiorespiratory Fitness and Hematological Parameters in People Recovered From COVID-19: The AEROBICOVID Study.

BACKGROUND: Recent studies have indicated that people who live at altitude have a lower incidence of coronavirus disease (COVID-19) and lesser severity in infection cases. HYPOTHESIS: Hypoxia exposure could lead to health benefits, and it could be used in the recovery process as an additional stimulus to physical training to improve cardiorespiratory fitness (CRF). STUDY DESIGN: Randomized controlled clinical trial. LEVEL OF EVIDENCE: Level 2. METHODS: The 43 participants, aged 30 to 69 years, were divided into control group (CG, n = 18) and 2 training groups: normoxia (NG, n = 9) and hypoxia (HG, n = 16). Before and after the intervention were evaluated the lactate threshold 2 (L2), peak oxygen uptake (VO2peak), and a blood sample was collected at rest to evaluate hematological adaptation. Both groups performed an 8-week moderate-intensity physical training on a bike. The HG were trained under normobaric hypoxic conditions (fractional inspired oxygen [FiO2] = 13.5%). RESULTS: The 8-week intervention promoted a similar improvement in CRF of people recovered from COVID-19 in the HG (L2 = 34.6%; VO2peak = 16.3%; VO2peak intensity = 24.6%) and NG (L2 = 42.6%; VO2peak = 16.7%; VO2peak intensity = 36.9%). Only the HG presented differences in hematological variables (erythropoietin = 191.7%; reticulocytes = -32.4%; off-score = 28.2%) in comparison with the baseline. CONCLUSION: The results of the present study provide evidence that moderate-intensity training in normoxia or hypoxia promoted similar benefits in CRF of people recovered from COVID-19. Furthermore, the hypoxia offered an additional stimulus to training promoting erythropoietin increase and hematological stimulation. CLINICAL RELEVANCE: The present exercise protocol can be used for the rehabilitation of people recovered from COVID-19, with persistent low CRF. In addition, this is the first study demonstrating that physical training combined with hypoxia, as well as improving CRF, promotes greater hematological stimulation in people recovered from COVID-19.

Can Hypoxia Alter the Anaerobic Capacity Measured by a Single Exhaustive Exercise?

The present study aimed to compare the MAODALT in situations of hypoxia and normoxia to confirm the method validity. Seventeen healthy and physically active men participated in this study, aged 25.2±3.2 years. All participants underwent four days of evaluation. The first day was performed a body composition test, an incremental test to exhaustion to determine the maximum oxygen uptake, familiarizing the hypoxia (H) and normoxia (N) situation and the equipment used. On the second, third and fourth days, supramaximal efforts were performed until exhaustion at 110% of maximum oxygen uptake, in a situation of hypoxia (FIO2=14.0%) and normoxia (FIO2=20.9%). The anaerobic capacity was considered the sum of energy supply of the alactic and lactic systens. The absolute or relative anaerobic capacity values were not different (H=3.9±1.1 L, N=3.8±0.9 L, p=0.69), similarly no differences were found for the alactic contribution (H=1.7±0.5 L, N=1.5±0.5 L, p=0.30) and lactic contribution (H=2.3±0.9 L, N=2.3±0.7 L, p=0.85). It can be concluded that the anaerobic capacity measured by a single exhaustive effort is not altered by hypoxia.

Associação entre prática de atividade física com a saúde mental e a percepção da qualidade de vida em profissionais de enfermagem de Ribeirão Preto e região durante a pandemia da covid-19 / Association among physical activity practice with the mental health and the quality of life perception in nursing professionals from Ribeirao Preto and the region during the COVID-19 pandemic

Introdução: Na linha de frente da pandemia da COVID-19 encontram-se os profissionais de saúde que realizam um intenso trabalho, incluindo os profissionais de enfermagem, que representam uma grande parcela entre os profissionais de saúde que atuam nas instituições de saúde e hospitalares. As altas pressões no ambiente de trabalho com elevadas cargas e jornadas aumentaram as demandas, devido à responsabilidade de suas atribuições. Este contexto pode trazer repercussões negativas para a prática da atividade física, saúde mental e percepção de qualidade de vida destes profissionais. Objetivo: Analisar a associação entre a prática de atividade física, saúde mental e a percepção da qualidade de vida em profissionais de enfermagem de Ribeirão Preto, SP durante a pandemia da COVID-19. Métodos: Trata-se de um estudo transversal realizado com profissionais de enfermagem de Ribeirão Preto e região em 2021, por meio de formulário online na ferramenta Google Forms. Foram realizadas perguntas relacionadas aos dados sociodemográficos, atividade profissional, questionários para medir nível de atividade física e comportamento sedentário (IPAQ ­ versão curta), percepção da qualidade de vida (SF ­ 12v2) e saúde mental (DASS-21). Sobre a análise estatística, utilizou-se o teste Qui-quadrado para verificar a associação de duas variáveis categóricas entre si; teste t de Student para comparar duas médias e a ANOVA para comparar três médias provenientes de amostras não pareadas. O nível de significância foi de 5%. Resultados: Participaram do estudo 125 profissionais de enfermagem, sendo auxiliares, técnicos, enfermeiros(as) e enfermeiros(as) coordenadores(as). Desses, 79,2% foram mulheres e 56% atuavam no setor privado, 34,4% estavam acima do peso e 29,6% com obesidade. Os profissionais que praticavam exercício físico ou esporte apresentaram menor risco de depressão (57,9% entre os que não praticavam, 47,9% entre os que praticavam um tipo e 18,2% entre os que praticavam dois ou mais tipos de exercício ou esporte, p = 0,04). Profissionais com moderado ou alto nível de atividade física e que praticavam exercícios físicos ou esportes, apresentaram melhor pontuação em diversos domínios e nos componentes físico e mental da qualidade de vida, quando comparados aos com baixo nível de atividade física e que não praticavam exercícios físicos ou esportes, respectivamente. Conclusão: Profissionais de enfermagem que relataram praticar mais exercícios físicos ou esporte apresentaram menor risco relacionado à saúde mental, e os que relataram nível moderado ou alto de atividade física apresentaram melhor percepção de qualidade de vida (AU).

Introduction: At the forefront of the COVID-19 pandemic are health professionals who carry out intense work, including nursing professionals, who represent a large number of health professionals working in health and hospital institutions. The high pressures in the work environment with expended workloads and journeys increased the demands due to the responsibility of their attributions. This context can negatively affect these professionals' physical activity practices, mental health, and perceived quality of life. Objective: Analyze the association between physical activity practice, mental health, and perceived quality of life in nursing professionals from Ribeirao Preto, SP, during the COVID-19 pandemic. Methods: This cross-sectional study was performed with nursing professionals from the Ribeirao Preto and region area in 2021 through an online form on the Google Forms tool. Questions related to sociodemographic data, professional activity, questionnaires to measure physical activity levels and sedentary behavior (IPAQ - short version), quality of life perception (SF - 12v2), and mental health (DASS-21) were used. Regarding the statistical analysis, the Chi-square test was used to verify the association of two categorical variables; the Student's T-test to compare two means, and the ANOVA to compare three means from unpaired samples. The significance level was 5%. Results: 125 professionals participated in the study, such as assistants, technicians, nurses, and coordinating nurses. Among them, 79.2% were women, 56.0% worked in the private sector, 34.4% were overweight, and 29.6% were obese. Professionals who practiced physical exercise or sport had a lower risk of depression (57.9% among non-practicing professionals, 47.9% among practicing one type of exercise, and 18.2% among practicing two or more types of exercise or sports, p = 0.04). In addition, professionals with moderate or high physical activity levels and who practiced physical exercises or sports had a better score in multiple domains and physical and mental quality of life components compared with low physical activity levels and not practicing physical exercises or sports, respectively. Conclusion: Nursing professionals who reported practicing more physical exercises or sports had lower mental health-related risks, and those who reported moderate or high physical activity levels had a better perception of quality of life (AU).

Effectiveness, implementation, and monitoring variables of intermittent hypoxic bicycle training in patients recovered from COVID-19: The AEROBICOVID study.

Hypoxic exposure is safely associated with exercise for many pathological conditions, providing additional effects on health outcomes. COVID-19 is a new disease, so the physiological repercussions caused by exercise in affected patients and the safety of exposure to hypoxia in these conditions are still unknown. Due to the effects of the disease on the respiratory system and following the sequence of AEROBICOVID research work, this study aimed to evaluate the effectiveness, tolerance and acute safety of 24 bicycle training sessions performed under intermittent hypoxic conditions through analysis of peripheral oxyhemoglobin saturation (SpO2), heart rate (HR), rate of perceived exertion (RPE), blood lactate concentration ([La-]) and symptoms of acute mountain sickness in patients recovered from COVID-19. Participants were allocated to three training groups: the normoxia group (GN) remained in normoxia (inspired fraction of O2 (FiO2) of ∼20.9%, a city with 526 m altitude) for the entire session; the recovery hypoxia group (GHR) was exposed to hypoxia (FiO2 ∼13.5%, corresponding to 3,000 m altitude) all the time except during the effort; the hypoxia group (GH) trained in hypoxia (FiO2 ∼13.5%) throughout the session. The altitude simulation effectively reduced SpO2 mean with significant differences between groups GN, GHR, and GH, being 96.9(1.6), 95.1(3.1), and 87.7(6.5), respectively. Additionally, the proposed exercise and hypoxic stimulus was well-tolerated, since 93% of participants showed no or moderate acute mountain sickness symptoms; maintained nearly 80% of sets at target heart rate; and most frequently reporting session intensity as an RPE of "3" (moderate). The internal load calculation, analyzed through training impulse (TRIMP), calculated using HR [TRIMPHR = HR * training volume (min)] and RPE [TRIMPRPE = RPE * training volume (min)], showed no significant difference between groups. The current strategy effectively promoted the altitude simulation and monitoring variables, being well-tolerated and safely acute exposure, as the low Lake Louise scores and the stable HR, SpO2, and RPE values showed during the sessions.

Physical activity in the post-COVID-19: AEROBICOVID project design and perspectives / Atividade física no pós-COVID-19: escopo do projeto AEROBICOVID e suas perspectivas

During the COVID-19 pandemic, several late-onset impairments have been observed, affecting the health and functionality of those involved. On the other hand, lower SARS-CoV-2 infection rates and severity of symptoms were observed in high-altitude cities. In this sense, the AEROBICOVID project was developed with the hypothesis that exercise would be an important opportunity for health improvement and that hypoxia would promote additional benefits in the recovery process. The cohort was about 84 participants with approximately 30 days since the COVID-19 symptoms recovery, 25 in the control group, and 59 divided into three moderate physical training groups. The project had good results in teaching, research, and extension, but also faced difficulties in operationalization. This experience is the basis for future proposals through an extension project at the University of São Paulo and in a Family Health Unit, besides a research project that will develop a new low-cost hypoxia technology (AU)

Durante a pandemia de COVID-19 estão sendo observados vários efeitos tardios, afetando a saúde e a funcionalidade dos acometidos. Por outro lado, foram observadas menores taxas de infecção pelo SARS-CoV-2 e gravidade dos sintomas em cidades de elevada altitude. Neste sentido, o projeto AEROBICOVID foi desenvolvido com a hipótese de que o exercício seria uma proposta importante para a melhoria da saúde e que a hipóxia promoveria benefícios adicionais no processo de recuperação. Participaram 84 pessoas com aproximadamente 30 dias desde a recuperação dos sintomas da COVID-19, 25 no grupo de controle e 59 divididos em três grupos de treinamento físico moderado. O projeto teve bons resultados no ensino, pesquisa e extensão, mas também enfrentou dificuldades na operacionalização. Estas experiências são a base para propostas futuras através de um projeto de extensão na Universidade de São Paulo e em uma Unidade de Saúde da Família, além de um projeto de pesquisa que desenvolverá uma nova tecnologia de hipóxia de baixo custo (AU)

Estratégias de marketing para manter e captar clientes durante a pandemia da Covid-19 em academias de Ribeirão Preto-SP, Brasil / Marketing strategies to maintain and attract customers during the Covid-19 pandemic in gyms of Ribeirao Preto-SP, Brazil / Estrategias de marketing para mantener y atraer clientes durante la pandemia del Covid-19 en los gimnasios de Ribeirao Preto-SP, Brasil

Introdução: O Brasil é o terceiro colocado no ranking mundial em faturamento de serviços fitness, com 34.509 academias registradas. Entretanto, a pandemia da Covid-19 trouxe desafios e uma queda nesse faturamento. Com isto, as academias foram forçadas a adotar novas estratégias de gestão e marketing para se manterem no mercado diante deste novo contexto. Objetivo: Identificar as estratégias de marketing esportivo utilizadas por gestores de academias de Ribeirão Preto/SP para manter e captar novos clientes durante a pandemia da Covid-19. Métodos: Realizou-se um estudo qualitativo por meio de entrevista semiestruturada, realizada por meio da ferramenta Google Meet, gravadas para serem transcritas e analisadas posteriormente. Resultados: Dentre as estratégias utilizadas pelos seis gestores entrevistados, destacaram-se: segurança e limpeza da academia como marketing; priorização do relacionamento com o cliente como principal forma de retenção; uso recorrente do marketing de bonificações; pacotes e mensalidades mais atrativos para manter e ao mesmo tempo captar novos clientes; e, a utilização das redes sociais como principal forma de captação. Os problemas encontrados pelos gestores foram similares, com ao menos 1/3 apontando a falta de verba específica para o marketing, campanhas centralizadas em outras sedes ou franquias, lives ineficientes e marketing tradicional com custo muito alto. Considerações finais: Os gestores precisaram superar os obstáculos da pandemia para planejar e promover estratégias de marketing para academias com objetivos, público e porte diferentes. Ainda existem poucos estudos relacionando marketing e o mercado fitness no Brasil, destacando a importância de mais estudos que abordem esta temática.

Introduction: Brazil is ranked third in the world in fitness service billing, with 34,509 registered gyms. However, the COVID-19 pandemic brought challenges and a drop in this revenue. Consequently, the gyms were forced to adopt new management and marketing strategies to stay in the market facing the contemporary context. Objective: To identify the sports marketing strategies used by gym managers in Ribeirão Preto, SP, Brazil, to keep and attract new customers during the COVID-19 pandemic. Methods: A qualitative study was performed through semi-structured interviews, conducted through the Google Meet tool, recorded to be transcribed and analyzed. Results: Among the strategies used by the six managers interviewed stand out: gym safety and cleanliness as marketing; the prioritization of the relationship with customers as the main form of retention; the overuse of bonus marketing; packages and more attractive monthly fees to keep and at the same time attract new customers; and, also the use of social networks as the main form of attraction. The problems were similar among the managers, with at least 1/3 indicating the lack of a specific budget for marketing, centralized campaigns in other locations or franchises, inefficient live broadcasts, and traditional marketing with a very high cost. Final words: The managers needed to overcome the pandemic obstacles to plan and promote marketing strategies for gyms with different objectives, public, and size. There are still few studies on the relationship between marketing and Brazil's fitness market, highlighting the importance of more studies that address this theme.

Introducción: Brasil es el tercer país del mundo en facturación de servicios fitness, con 34.509 gimnasios registrados. Sin embargo, la pandemia de Covid-19 llevó a desafíos y un descenso de estos ingresos. Con esto, los gimnasios se vieron obligados a adoptar nuevas estrategias de gestión y comercialización para mantenerse en el mercado ante el nuevo contexto. Objetivo: Identificar las estrategias de marketing deportivo utilizadas por los gestores de gimnasios de Ribeirão Preto, SP, Brasil, para mantener y atraer nuevos clientes durante la pandemia de Covid-19. Métodos: Se realizó un estudio cualitativo a través de entrevista con preguntas preestablecidas, realizadas por la herramienta Google Meet, grabadas para poder transcribirlas y analizarlas. Resultados: Entre las estrategias utilizadas por los seis gestores entrevistados, se destacaron: seguridad y limpieza del gimnasio como marketing; priorización de las relaciones con los clientes como principal forma de retención; el abuso del marketing de bonos; paquetes y cuotas mensuales más atractivas para mantener y al mismo tiempo captar nuevos clientes; y, también el uso de las redes sociales como principal forma de captación. Los problemas encontrados por los gestores fueron similares, con al menos 1/3 apuntando falta de presupuesto específico para el marketing, campañas centralizadas en otras sedes o franquicias, lives ineficientes y el marketing tradicional como una estrategia de muy alto coste. Consideraciones finales: Los gestores necesitaron superar los obstáculos de la pandemia para planificar y promover estrategias de marketing para gimnasios con objetivos, público y tamaño distintos. Todavía hay pocos estudios que relacionen el marketing y el mercado fitness en Brasil, destacando la importancia de más estudios que aborden este tema.