Do older people with poor sleep quality have worse cardiac autonomic control?

Objective: To identify the differences in cardiac autonomic control between older people with good and poor sleep quality. Material and Methods: This is a cross-sectional study with 40 older people aged ≥ 60 years, registered at a community health center in Petrolina, Pernambuco, Brazil. The sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI). To assess heart rate variability (HRV), the RR intervals (RRI) were recorded for 10 min with a validated smartphone app and a wireless transmitter Polar H7 positioned on the patient's chest. The HRV parameters were calculated with Kubios HRV, and the data were analyzed in SPSS. Subjects with good and poor sleep quality (PSQI >5) were compared with the Mann-Whitney U test. Results: A total of 31 older people were included in the final analysis, with 18 (58.1%) of them having poor sleep quality. Older people with good sleep quality have similar cardiac autonomic control to those with poor sleep quality. The medians of time (mean RRI, pNN50, SDNN, and RMSSD) and frequency-domain HRV parameters (LFms2, LFnu, HFms2, HFnu, and LF/HF ratio) were statistically similar (p > .05) in older people with good and poor sleep quality. According to the effect size, the HRV indicators were slightly better among those with good sleep quality. Conclusion: There were no statistical differences in cardiac autonomic control between older people with good and poor sleep quality.

Cardiopulmonary Exercise Testing with Elastic Resistance: A New Reproducible Proposal for Determination of Ventilatory Thresholds and Maximum Oxygen Consumption.

To propose a new Cardiopulmonary Exercise Test with Elastic Resistance (CPxEL) and compare the physiological responses to conventional cardiopulmonary exercise test (CPx) performed on a treadmill. In addition, we tested the reproducibility of the CPxEL. Twenty-four physically active participants completed the CPx (first session) and CPxEL twice (second and third sessions) interspersed by seven days. A treadmill protocol with increments of 1km·h-1 every minute until exhaustion was used in CPx. The CPxEL consisted of performing alternating steps back-and-forth against an elastic resistance attached to a belt and an incremental protocol with 1 stage (S) per minute following a cadence of 200 bpm controlled by a metronome in an 8-stage rubber mat. First analysis: first ventilatory threshold (VT1) occurred at 69.7% and 75.3% of maximal heart rate (HRmax) and 53.5% and 65.7% of maximal oxygen consumption (V̇O2max). Second VT (VT2) occurred at 93.3% and 96.8% of the HRmax and 87.0% and 96.9% of V̇O2max for CPx and CPxEL, respectively. At exhaustion, V̇O2max, perceived exertion (BORG-CR10 and OMNI-RES EB), and test duration presented lower values for CPxEL (P < 0.05). Second analysis: VT1 occurred at warm-up (S0) (P = 0.731), VT2 occurred at S5 (P = 0.912), and the exhaustion occurred at S6 and S7 (P = 0.271) for CPxEL and retest, respectively. The intraclass correlation coefficient (ICC) for V̇O2max was 0.921 and for HRmax was 0.930. The CPxEL has good test-retest reproducibility and represents a possible and interesting add-on to determine maximal oxygen consumption, maximal heart rate, and second ventilatory threshold without using traditional ergometers.

Carbohydrate mouth rinse improves cycling performance carried out until the volitional exhaustion.

BACKGROUND: Carbohydrates (CHO) are among the most investigated nutritional ergogenic aids, and may be consumed in different forms, e.g., mouth rinse with carbohydrate solution (MRCS). In this sense, the aim of this study was to evaluate the impact of MRCS on the performance of physically active individuals undergoing a physical exercise session carried out until the volitional exhaustion. METHODS: This is a counter-balanced randomized study, with a double-blind design. The sample consisted of twenty-one physically active healthy men with a mean (±SD) of age of 22.4 (±2.7) years old, 76.7 (±6.0) cm of height,12.1% (±3.7) of body fat mass, and 23.9 (±2.4) kg/m2 of body mass index. After familiarizing the participants with the protocol (cycle ergometer, with oral mouth rinse procedure) and assessing the maximal lactate steady state the cycling exercise was performed until the volitional exhaustion in the following conditions: without mouth rinse (CONTROL), PLACEBO and MRCS. RESULTS: Time to reach exhaustion was statistically different (P<0.0001) between conditions (control: 43.0±27.5 minutes; placebo: 57.4±30.6 minutes; MRCS: 70.9±30.3 minutes). CONCLUSIONS: The administration of MRCS was shown to be effective in improving cycling performance, increasing the time to exhaustion until the volitional exhaustion. Thus, the use of methodology proposed by the present study may help coaches and practitioners improve the performance of physically active young adults.

Suicide attempts in bipolar I patients: impact of comorbid personality disorders

Objective: To evaluate the association between personality disorders (PDs) and suicide attempts (SAs) in euthymic patients with type I bipolar disorder (BD). Methods: One-hundred twenty patients with type I BD, with and without history of SA, were evaluated during euthymia. The assessment included a clinical and sociodemographic questionnaire, the Hamilton Depression Rating Scale, the Young Mania Rating Scale, the Barratt Impulsiveness Scale, and Structured Clinical Interviews for DSM-IV Axis I and II Disorders. Logistic regression was employed to determine associations between history of SA and patient characteristics. Results: History of SA was significantly associated with comorbid axis I disorder, rapid cycling, high impulsivity (attentional, motor, non-planning, and total), having any PD, and cluster B and C PDs. Only cluster B PDs, high attentional impulsivity, and lack of paid occupation remained significant after multivariate analysis. Conclusions: Cluster B PDs were significantly associated with SA in patients with type I BD. High attentional impulsivity and lack of gainful employment were also associated with SA, which suggests that some cluster B clinical and social characteristics may exacerbate suicidal behavior in this population. This finding offers alternatives for new therapeutic interventions.

Suicide attempts in bipolar I patients: impact of comorbid personality disorders.

Objective: To evaluate the association between personality disorders (PDs) and suicide attempts (SAs) in euthymic patients with type I bipolar disorder (BD). Methods: One-hundred twenty patients with type I BD, with and without history of SA, were evaluated during euthymia. The assessment included a clinical and sociodemographic questionnaire, the Hamilton Depression Rating Scale, the Young Mania Rating Scale, the Barratt Impulsiveness Scale, and Structured Clinical Interviews for DSM-IV Axis I and II Disorders. Logistic regression was employed to determine associations between history of SA and patient characteristics. Results: History of SA was significantly associated with comorbid axis I disorder, rapid cycling, high impulsivity (attentional, motor, non-planning, and total), having any PD, and cluster B and C PDs. Only cluster B PDs, high attentional impulsivity, and lack of paid occupation remained significant after multivariate analysis. Conclusions: Cluster B PDs were significantly associated with SA in patients with type I BD. High attentional impulsivity and lack of gainful employment were also associated with SA, which suggests that some cluster B clinical and social characteristics may exacerbate suicidal behavior in this population. This finding offers alternatives for new therapeutic interventions.

Assessment of Body Composition and Sport Performance of Brazilian Paralympic Swim Team Athletes.

CONTEXT: Body-composition assessments of high-performance athletes are very important for identifying physical performance potential. Although the relationship between the kinanthropometric characteristics and performance abilities of Olympic swimmers is extremely important, this subject is not completely understood for Paralympic swimmers. OBJECTIVE: To investigate the relationship between body composition and sport performance in Brazilian Paralympic swimmers 6 mo after training. DESIGN: Experimental pre/posttest design. SETTING: Research laboratory and field evaluations of swimming were conducted to verify the 50-m freestyle time of each athlete. PARTICIPANTS: 17 Brazilian Paralympic swim team athletes (12 men, 5 women). MAIN OUTCOME MEASURES: Body-composition assessments were performed using a BOD POD, and swimming performance was assessed using the 50-m freestyle, which was performed twice: before and after 6 mo of training. RESULTS: Increased lean mass and significantly reduced relative fat mass and swimming time (P < .05) were observed 6 mo after training. Furthermore, a positive correlation between body-fat percentage and performance (r = .66, P < .05) was observed, but there was no significant correlation between body density and performance (r = -.14, P > .05). CONCLUSIONS: After a 6-mo training period, Paralympic swimmers presented reduced fat mass and increased lean body mass associated with performance, as measured by 50-m freestyle time. These data suggest that reduced fat-mass percentage was significantly correlated with improved swimming performance in Paralympic athletes.

Revisiting the Heterogeneous IFN-γ Response of Bacille of Calmette-Guérin (BCG)-Revaccinated Healthy Volunteers in a Randomized Controlled Trial: Effect of the Body Mass Index and of the IFNG+874 A/T Polymorphism.

In trials evaluating the immune responses to Bacille of Calmette-Guérin (BCG), the genetic background and the nutritional status are host-related factors that could affect the heterogeneity in these parameters. The IFNG+874 A/T (rs 62559044) polymorphism has been reported to influence the IFN-γ production by BCG-vaccinated individuals challenged in vitro with mycobacterial antigens. The body mass index (BMI) is a proxy for the nutritional status and has been associated both with the susceptibility to tuberculosis and with the IFN-γ response. We show that although the IFNG+874 A/T polymorphism was not associated with the heterogeneity of IFN-γ production in a randomized controlled trial that evaluated long-term immune responses to BCG revaccination previously conducted in Salvador, Bahia, Brazil, the effect of this polymorphism on the observed increase in IFN-γ production among revaccinated subjects was adjusted in individuals with a low BMI.

Incremental exercise test for the evaluation of peak oxygen consumption in paralympic swimmers.

BACKGROUND: Peak oxygen consumption (VO2peak) is a fundamental parameter used to evaluate physical capacity. The objective of this study was to explore two types of incremental exercise tests used to determine VO2peak in four Paralympic swimmers: arm ergometer testing in the laboratory and testing in the swimming pool. METHODS: On two different days, the VO2peak values of the four athletes were measured in a swimming pool and by a cycle ergometer. The protocols identified the VO2peak by progressive loading until the volitional exhaustion maximum was reached. The results were analyzed using the paired Student's t-test, Cohen's d effect sizes and a linear regression. RESULTS: The results showed that the VO2peak values obtained using the swimming pool protocol were higher (P=0.02) than those obtained by the arm ergometer (45.8±19.2 vs. 30.4±15.5; P=0.02), with a large effect size (d=3.20). When analyzing swimmers 1, 2, 3 and 4 individually, differences of 22.4%, 33.8%, 60.1% and 27.1% were observed, respectively. CONCLUSIONS: Field tests similar to the competitive setting are a more accurate way to determine the aerobic capacity of Paralympic swimmers. This approach provides more sensitive data that enable better direction of training, consequently facilitating improved performance.

Association between nonalcoholic fatty liver disease and coronary artery disease / Associação entre doença hepática gordurosa não-alcoólica e doença arterial coronariana

OBJECTIVE: Although some investigations have shown a relationship between nonalcoholic fatty liver disease (NAFLD) and cardiovascular diseases, there are few studies analyzing the relationship between NAFLD and coronary artery disease (CAD). The aim of this article was to review the relationship between NAFLD and CAD and the methods of diagnosis used to assess such relationship. METHODS: A review was performed using search engines of indexed scientific material, including MEDLINE (by PubMed), Web of Science, IBECS, and LILACS, to identify articles published in Portuguese, English, and Spanish until August, 2012. The studies were eligible if they included the following data: place and year of publication, prevalence and methods used to diagnose NAFLD (ultrasound, computed tomography, nuclear magnetic resonance, or biopsy) and CAD (coronary angiography, or computed tomography), and the exclusion of patients due to alcohol consumption greater than 20 g/day. RESULTS: Ten articles were selected, most of which were cross-sectional studies. The studies mostly observed the association between NAFLD and the presence and severity of CAD. CONCLUSION: The analysis of the review showed that evaluating the existence of NAFLD in patients with CAD from its subclinical form up to the symptomatic clinical form is important due to the higher risk of acute myocardial infarction and consequent increase of mortality.

OBJETIVO: Embora algumas investigações demonstrem uma associação entre a doença hepática gordurosa não-alcoólica (DHGNA) e doenças cardiovasculares, existem poucos estudos analisando a relação entre DHGNA e doença arterial coronariana (DAC). O objetivo deste artigo foi realizar uma revisão sobre a associação entre DHGNA e CAD e os métodos diagnósticos usados para avaliar esta associação. MÉTODOS: Foi realizada uma revisão da literatura utilizando métodos de busca de material científico indexado, incluindo MEDLINE (através do PubMed), Web of Science, IBECS e LILACS, para identificar artigos publicados em português, inglês e espanhol até agosto de 2012. Os estudos eram elegíveis se incluíam os seguintes dados: local e ano de publicação, prevalência e os métodos utilizados para o diagnóstico da DHGNA (ultrassonografia, tomografia computadorizada, ressonância nuclear magnética ou biópsia) e DAC (angiografia coronária ou tomografia computadorizada),e a exclusão de pacientes com consumo de álcool maior do que 20 g/dia. RESULTADOS: Dez artigos foram selecionados, predominando os estudos de corte transversal. Na maioria dos estudos foi observada a associação entre DHGNAeapresença e gravidade da DAC. CONCLUSÃO: A análise da revisão mostra que é importante avaliar a existência de DHGNA em pacientes com DAC desde sua forma subclínica até a forma clínica sintomática, devido ao maior risco de infarto agudo do miocárdio e consequente aumento da mortalidade.

Association between nonalcoholic fatty liver disease and coronary artery disease.

OBJECTIVE: Although some investigations have shown a relationship between nonalcoholic fatty liver disease (NAFLD) and cardiovascular diseases, there are few studies analyzing the relationship between NAFLD and coronary artery disease (CAD). The aim of this article was to review the relationship between NAFLD and CAD and the methods of diagnosis used to assess such relationship. METHODS: A review was performed using search engines of indexed scientific material, including MEDLINE (by PubMed), Web of Science, IBECS, and LILACS, to identify articles published in Portuguese, English, and Spanish until August, 2012. The studies were eligible if they included the following data: place and year of publication, prevalence and methods used to diagnose NAFLD (ultrasound, computed tomography, nuclear magnetic resonance, or biopsy) and CAD (coronary angiography, or computed tomography), and the exclusion of patients due to alcohol consumption greater than 20g/day. RESULTS: Ten articles were selected, most of which were cross-sectional studies. The studies mostly observed the association between NAFLD and the presence and severity of CAD. CONCLUSION: The analysis of the review showed that evaluating the existence of NAFLD in patients with CAD from its subclinical form up to the symptomatic clinical form is important due to the higher risk of acute myocardial infarction and consequent increase of mortality.

Predicting one repetition maximum equations accuracy in paralympic rowers with motor disabilities.

Predicting one repetition maximum equations accuracy in paralympic rowers Resistance training intensity is prescribed using percentiles of the maximum strength, defined as the maximum tension generated for a muscle or muscular group. This value is found through the application of the one maximal repetition (1RM) test. One maximal repetition test demands time and still is not appropriate for some populations because of the risk it offers. In recent years, the prediction of maximal strength, through predicting equations, has been used to prevent the inconveniences of the 1RM test. The purpose of this study was to verify the accuracy of 12 1RM predicting equations for disabled rowers. Nine male paralympic rowers (7 one-leg amputated rowers and 2 cerebral paralyzed rowers; age, 30 +/- 7.9 years; height, 175.1 +/- 5.9 cm; weight, 69 +/- 13.6 kg) performed 1RM test for lying T-bar row and flat barbell bench press exercises to determine upper-body strength and leg press exercise to determine lower-body strength. One maximal repetition test was performed, and based on submaximal repetitions loads, several linear and exponential equations models were tested with regard of their accuracy. We did not find statistical differences for lying T-bar row and bench press exercises between measured and predicted 1RM values (p = 0.84 and 0.23 for lying T-bar row and flat barbell bench press, respectively); however, leg press exercise reached a high significant difference between measured and predicted values (p < 0.01). In conclusion, rowers with motor disabilities tolerate 1RM testing procedures, and predicting 1RM equations are accurate for bench press and lying T-bar row, but not for leg press, in this kind of athlete.