Factors associated with the quality of life of mothers of preterm infants with very low birth weight: a 3-year follow-up study.

AIM: To analyze possible factors associated with the quality of life (QoL) of mothers of preterm infants with very low birth weight (VLBW) during the first 3 years after delivery. METHODS: The World Health Organization Quality of Life (WHOQOL)-bref scores were compared and correlated with maternal and infant-related sociodemographic and clinical variables at maternal discharge (T0) and at 6 (T1), 12 (T2), 24 (T3), and 36 (T4) months after delivery. Multiple linear regression models were fitted to investigate the effect of these variables on the mothers' QoL. RESULTS: The WHOQOL-BREF physical domain scores were higher at T1 and T2 compared to T0 (p = 0.013). Maternal variables that contributed to maternal QoL scores (p < 0.05) were stable marital union (b = 13.60; T0), family income (b = -12.75; T3), Evangelical religion (b = 8.11; T4), and beck depression inventory (BDI) score (-1.42 ≤ b ≤ -0.36; T0, T1, T2, T3, and T4). Infants' variables that most affected maternal QoL (p < 0.05) were posthemorrhagic hydrocephalus (PHH) (-18.84 ≤ b ≤ -10.05; T1, T2, and T4), bronchopulmonary dysplasia (BPD) (b = -7.41; T2), female gender (b = 8.09; T2), and SNAPPE severity score (b = -0.23; T3). CONCLUSION: Mothers of preterm infants with VLBW exhibited transient improvements in physical well-being during the first year after delivery. The presence of depressive symptoms in mothers and the diagnosis of PHH or BPD were negatively associated with QoL. Social, religious, and economic aspects were also important factors for the QoL of mothers of preterm infants with VLBW.

Acute hemodynamic and electrocardiographic responses to a session of inspiratory muscle training in cardiopulmonary rehabilitation.

BACKGROUND: Inspiratory muscle training (IMT) has been shown to generate significant benefits in different clinical conditions; however, there is scarce information regarding acute clinical and hemodynamic effects. AIM: The aim of this study was to evaluate clinical, hemodynamic and electrocardiographic responses during a single short IMT session in patients enrolled in cardiopulmonary rehabilitation program (CRP). DESIGN: Cross-sectional study. SETTING: Patients referred and regularly attending a non-hospital based medically-supervised exercise program. POPULATION: One hundred and sixty patients patients who regularly performed inspiratory muscle training METHODS: A convenience sample of 21 elderly patients (16 men; 60-87 years of age) had an ECG continuously recorded and heart rate (HR) and blood pressure (BP) measured before, during and one-minute after a single IMT session - two sets of 15 cycles with one-minute interval. RESULTS: Comparing values obtained before, during second set and one-minute after IMT, no differences were found to HR (bpm) - 68±2 vs. 70±2 vs. 66±3 (P=0.05) and in systolic and diastolic BP (mm Hg) values, respectively, - 105±3 vs. 111±4 vs. 108±3 (P=0.06) and - 68±2 vs. 72±3 vs. 68±2 (P=0.14); (before, during second set and one-minute after TMI). During IMT, seven (33%) of patients presented minor cardiac arrhythmias, most of them isolated premature ventricular contractions. Additionally, no abnormal signs or symptoms were found. CONCLUSION: Apart of minor and clinically irrelevant ECG abnormalities seen in 1/3 of the patients, a short IMT session did not induce significant hemodynamic responses or relevant clinical abnormalities. Based on these results, for elderly patients involved in CPR, IMT seems to be clinically safe and continuous ECG monitoring did not seem to add significant or relevant information. CLINICAL REHABILITATION IMPACT: For elderly patients participating in CPR, short IMT sessions do not induce major hemodynamic responses and seem to be clinically safe. This is potentially useful information if IMT is to be prescribed in home-based programs.

Cardiac vagal index does not explain age-independent maximal heart rate.

Cardiac vagal tone (CVT), a key determinant of resting heart rate (HR), is progressively withdrawn with incremental exercise and nearly abolished at maximal effort. While maximal HR decreases with age, there remains a large interindividual variability of results for any given age. In the present study, we hypothesized that CVT does not contribute to age-independent maximal HR. Data were obtained from 1 000 (39±14 years old) healthy subjects (719 men) who were not taking medications affecting CVT or maximal HR performed a clinically normal and truly maximal cardiopulmonary exercise testing. CVT was estimated using the cardiac vagal index (CVI), a dimensionless ratio obtained by dividing 2 cardiac cycle durations--end of exercise and pre-exercise--, reflecting HR increases during a 4-s unloaded cycling test (a vagally-mediated response). Maximal HR was expressed as % of that predicted by age (208-0.7 × age (years)). Linear regression analyses identified that CVI can explain only 1% of the % age-predicted maximal HR variability with a high standard error of estimate (~6.3%), indicating the absence of a true physiological cause-effect relationship. In conclusion, the influence of CVI on % of age-predicted maximal HR is null in healthy subjects, suggesting distinct physiological mechanisms and potential clinical complementary role for these exercise-related variables.

Psychiatric disorders and cardiac anxiety in exercising and sedentary coronary artery disease patients: a case-control study

Regular physical exercise has been shown to favorably influence mood and anxiety; however, there are few studies regarding psychiatric aspects of physically active patients with coronary artery disease (CAD). The objective of the present study was to compare the prevalence of psychiatric disorders and cardiac anxiety in sedentary and exercising CAD patients. A total sample of 119 CAD patients (74 men) were enrolled in a case-control study. The subjects were interviewed to identify psychiatric disorders and responded to the Cardiac Anxiety Questionnaire. In the exercise group (N = 60), there was a lower prevalence (45 vs 81%; P < 0.001) of at least one psychiatric diagnosis, as well as multiple comorbidities, when compared to the sedentary group (N = 59). Considering the Cardiac Anxiety Questionnaire, sedentary patients presented higher scores compared to exercisers (mean ± SEM = 55.8 ± 1.9 vs 37.3 ± 1.6; P < 0.001). In a regression model, to be attending a medically supervised exercise program presented a relevant potential for a 35% reduction in cardiac anxiety. CAD patients regularly attending an exercise program presented less current psychiatric diagnoses and multiple mental-related comorbidities and lower scores of cardiac anxiety. These salutary mental effects add to the already known health benefits of exercise for CAD patients.

Psychiatric disorders and cardiac anxiety in exercising and sedentary coronary artery disease patients: a case-control study.

Regular physical exercise has been shown to favorably influence mood and anxiety; however, there are few studies regarding psychiatric aspects of physically active patients with coronary artery disease (CAD). The objective of the present study was to compare the prevalence of psychiatric disorders and cardiac anxiety in sedentary and exercising CAD patients. A total sample of 119 CAD patients (74 men) were enrolled in a case-control study. The subjects were interviewed to identify psychiatric disorders and responded to the Cardiac Anxiety Questionnaire. In the exercise group (N = 60), there was a lower prevalence (45 vs 81%; P < 0.001) of at least one psychiatric diagnosis, as well as multiple comorbidities, when compared to the sedentary group (N = 59). Considering the Cardiac Anxiety Questionnaire, sedentary patients presented higher scores compared to exercisers (mean ± SEM = 55.8 ± 1.9 vs 37.3 ± 1.6; P < 0.001). In a regression model, to be attending a medically supervised exercise program presented a relevant potential for a 35% reduction in cardiac anxiety. CAD patients regularly attending an exercise program presented less current psychiatric diagnoses and multiple mental-related comorbidities and lower scores of cardiac anxiety. These salutary mental effects add to the already known health benefits of exercise for CAD patients.

A pre-season comparison of aerobic fitness and flexibility of younger and older professional soccer players.

Aerobic fitness and flexibility generally present age-related decreases, yet the influence of age on these variables in soccer players is still unknown. We obtained oxygen consumption (VO(2)) and heart rate (HR) at 12 km · h (- 1), anaerobic threshold and maximum intensities, and athletes' flexibility profiles using Flexitest (FLX). Pre-season data (2005-2011) from the 2 extreme age terciles (n=54) - YOUNGER (17-22 years old) and OLDER (27-36 years old) - of a group of 162 players from an elite Brazilian soccer club were compared. The effects of aging were also assessed by contrasting VO(2), HR and FLX linear regressions - slope and intercept - vs. age-predicted and reference values. The results were similar between the YOUNGER and OLDER terciles for VO(2max), at 62.7 ± 6.1 vs. 63.2 ± 6.2 mL · kg (- 1) · min (- 1), respectively (p=0.67), effect size (ES)=0.08, and for FLX, at 43 ± 5.9 vs. 41 ± 6.0, respectively (p=0.11, ES=0.34); the YOUNGER tercile exhibited higher values for HRmax than the OLDER tercile, at 194 ± 8.1 vs. 189 ± 8.8 b · min (- 1), (p<0.01, ES=0.59). Players in the OLDER tercile did not present an age-predicted decrease in VO(2max), whereas HRmax and FLX diminished with age as predicted. We conclude that, at least for these variables, younger and older players were effectively identical in their pre-season levels of conditioning.

Stability of relative oxygen pulse curve during repeated maximal cardiopulmonary testing in professional soccer players.

During cardiopulmonary exercise testing (CPET), stroke volume can be indirectly assessed by O(2) pulse profile. However, for a valid interpretation, the stability of this variable over time should be known. The objective was to analyze the stability of the O(2) pulse curve relative to body mass in elite athletes. VO(2), heart rate (HR), and relative O(2) pulse were compared at every 10% of the running time in two maximal CPETs, from 2005 to 2010, of 49 soccer players. Maximal values of VO(2) (63.4 ± 0.9 vs 63.5 ± 0.9 mL O(2)•kg(-1)•min(-1)), HR (190 ± 1 vs188 ± 1 bpm) and relative O(2) pulse (32.9 ± 0.6 vs 32.6 ± 0.6 mL O(2)•beat(-1)•kg(-1)) were similar for the two CPETs (P > 0.05), while the final treadmill velocity increased from 18.5 ± 0.9 to 18.9 ± 1.0 km/h (P < 0.01). Relative O(2) pulse increased linearly and similarly in both evaluations (r(2) = 0.64 and 0.63) up to 90% of the running time. Between 90 and 100% of the running time, the values were less stable, with up to 50% of the players showing a tendency to a plateau in the relative O(2) pulse. In young healthy men in good to excellent aerobic condition, the morphology of the relative O(2) pulse curve is consistent up to close to the peak effort for a CPET repeated within a 1-year period. No increase in relative O(2)pulse at peak effort could represent a physiologic stroke volume limitation in these athletes.

Stability of relative oxygen pulse curve during repeated maximal cardiopulmonary testing in professional soccer players

During cardiopulmonary exercise testing (CPET), stroke volume can be indirectly assessed by O2 pulse profile. However, for a valid interpretation, the stability of this variable over time should be known. The objective was to analyze the stability of the O2 pulse curve relative to body mass in elite athletes. VO2, heart rate (HR), and relative O2 pulse were compared at every 10 percent of the running time in two maximal CPETs, from 2005 to 2010, of 49 soccer players. Maximal values of VO2 (63.4 ± 0.9 vs 63.5 ± 0.9 mL O2•kg-1•min-1), HR (190 ± 1 vs188 ± 1 bpm) and relative O2 pulse (32.9 ± 0.6 vs 32.6 ± 0.6 mL O2•beat-1•kg-1) were similar for the two CPETs (P > 0.05), while the final treadmill velocity increased from 18.5 ± 0.9 to 18.9 ± 1.0 km/h (P < 0.01). Relative O2 pulse increased linearly and similarly in both evaluations (r² = 0.64 and 0.63) up to 90 percent of the running time. Between 90 and 100 percent of the running time, the values were less stable, with up to 50 percent of the players showing a tendency to a plateau in the relative O2 pulse. In young healthy men in good to excellent aerobic condition, the morphology of the relative O2 pulse curve is consistent up to close to the peak effort for a CPET repeated within a 1-year period. No increase in relative O2pulse at peak effort could represent a physiologic stroke volume limitation in these athletes.

Atrial fibrillation in endurance-trained athletes.

BACKGROUND: Endurance exercise training produces multiple cardiac adaptations including changes in electrophysiological function that may make endurance-trained athletes more vulnerable to atrial fibrillation (AF). This possible association is not recognised by many practising cardiologists and sports physicians. Consequently, we performed a literature review to examine the relationship between atrial fibrillation and endurance exercise training among athletes. PubMed was searched from January 1960 through December 2008 to identify articles examining the relationship between endurance exercise training and AF. RESULTS: Evidence suggests that athletes are at increased risk for development of AF. Possible factors increasing AF in this population include increased parasympathetic tone, reduced sympathetic tone, increased atrial size and increased inflammation. DISCUSSION: Suggested management of AF in athletes should follow similar principles to those used to manage AF in the general population.

Training-related changes in the R-R interval at the onset of passive movements in humans.

The aim of the present study was to determine whether training-related alterations in muscle mechanoreflex activation affect cardiac vagal withdrawal at the onset of exercise. Eighteen male volunteers divided into 9 controls (26 +/- 1.9 years) and 9 racket players (25 +/- 1.9 years) performed 10 s of voluntary and passive movement characterized by the wrist flexion of their dominant and non-dominant limbs. The respiratory cycle was divided into four phases and the phase 4 R-R interval was measured before and immediately following the initiation of either voluntary or passive movement. At the onset of voluntary exercise, the decrease in R-R interval was similar between dominant and non-dominant forearms in both controls (166 +/- 20 vs 180 +/- 34 ms, respectively; P > 0.05) and racket players (202 +/- 29 vs 201 +/- 31 ms, respectively; P > 0.05). Following passive movement, the non-dominant forearm of racket players elicited greater changes than the dominant forearm (129 +/- 30 vs 77 +/- 17 ms; P < 0.05), as well as both the dominant (54 +/- 20 ms; P < 0.05) and non-dominant (59 +/- 14 ms; P < 0.05) forearms of control subjects. In contrast, changes in R-R interval elicited by the racket players' dominant forearm were similar to that observed in the control group, indicating that changes in R-R interval at the onset of passive exercise were not attenuated in the dominant forearm of racket players. In summary, cardiac vagal withdrawal induced by muscle mechanoreflex stimulation is well-maintained, despite long-term exposure to training.

Training-related changes in the R-R interval at the onset of passive movements in humans

The aim of the present study was to determine whether training-related alterations in muscle mechanoreflex activation affect cardiac vagal withdrawal at the onset of exercise. Eighteen male volunteers divided into 9 controls (26 ± 1.9 years) and 9 racket players (25 ± 1.9 years) performed 10 s of voluntary and passive movement characterized by the wrist flexion of their dominant and non-dominant limbs. The respiratory cycle was divided into four phases and the phase 4 R-R interval was measured before and immediately following the initiation of either voluntary or passive movement. At the onset of voluntary exercise, the decrease in R-R interval was similar between dominant and non-dominant forearms in both controls (166 ± 20 vs 180 ± 34 ms, respectively; P > 0.05) and racket players (202 ± 29 vs 201 ± 31 ms, respectively; P > 0.05). Following passive movement, the non-dominant forearm of racket players elicited greater changes than the dominant forearm (129 ± 30 vs 77 ± 17 ms; P < 0.05), as well as both the dominant (54 ± 20 ms; P < 0.05) and non-dominant (59 ± 14 ms; P < 0.05) forearms of control subjects. In contrast, changes in R-R interval elicited by the racket players' dominant forearm were similar to that observed in the control group, indicating that changes in R-R interval at the onset of passive exercise were not attenuated in the dominant forearm of racket players. In summary, cardiac vagal withdrawal induced by muscle mechanoreflex stimulation is well-maintained, despite long-term exposure to training.

Atividade física e saúde

Com a participação de autoridades na área de medicina do esporte do país o documento traz um posicionamento oficial sobre o tema “Atividade Física e Saúde”, com os objetivos de: estabelecer os benefícios da atividade física; caracterizar os elementos de avaliação e prescrição do exercício para a saúde; instrumentalizar os profissionais de saúde para o uso eficiente da atividade física.

Psychotria hoffmansegiana (Willd ex Roem. & Schult.) Mull. Arg. and Palicourea marcagravii st. Hil. (Rubiaceae): potential for forming soil seed banks in a brazilian Cerrado.

The germinability of artificially buried Psychotria hoffmansegiana and Palicourea marcagravii seeds in Cerrado soil was tested, with the aim of evaluating whether dispersed seeds may be able to form a soil seed bank. The assays were carried out at a Cerrado Reserve in São Paulo State, Brazil. Seed samples were placed in nylon bags and buried at two different depths and in two different sites. Samples were periodically exhumed and germination tests were performed with both exhumed and dry stored seeds. In general, soil storage favoured seed survival and germination when compared to dry stored seeds. The seed germination was little affected by soil depth and by burial environment. Seeds of both species remained viable for at least 13 months, considering the time lapse between the collection and the end of the germination tests. It was suggested that both species can potentially form a persistent soil seed bank in Cerrado.

Psychotria hoffmansegiana (Willd ex Roem. & Schult.) Mull. Arg. and Palicourea marcagravii st. Hil. (Rubiaceae): potential for forming soil seed banks in a brazilian Cerrado

The germinability of artificially buried Psychotria hoffmansegiana and Palicourea marcagravii seeds in Cerrado soil was tested, with the aim of evaluating whether dispersed seeds may be able to form a soil seed bank. The assays were carried out at a Cerrado Reserve in São Paulo State, Brazil. Seed samples were placed in nylon bags and buried at two different depths and in two different sites. Samples were periodically exhumed and germination tests were performed with both exhumed and dry stored seeds. In general, soil storage favoured seed survival and germination when compared to dry stored seeds. The seed germination was little affected by soil depth and by burial environment. Seeds of both species remained viable for at least 13 months, considering the time lapse between the collection and the end of the germination tests. It was suggested that both species can potentially form a persistent soil seed bank in Cerrado.

Observou-se a germinabilidade de sementes de Psychotria hoffmansegiana e Palicourea marcagravii enterradas em solo de Cerrado, buscando-se avaliar o potencial de formação de banco de sementes no solo. Ensaios foram realizados em uma Reserva de Cerrado, São Paulo, Brasil. Amostras de sementes foram colocadas em sacos de tela de nylon e enterradas em duas profundidades, e em dois ambientes. Amostras eram periodicamente desenterradas e submetidas a teste de germinação, juntamente com sementes armazenadas em laboratório. Em geral, o armazenamento no solo favoreceu a sobrevivência e a capacidade de germinação das sementes, em comparação com sementes armazenadas em laboratório. A germinação foi pouco afetada pela profundidade de enterramento e pelo ambiente. Sementes de ambas as espécies conservaram a viabilidade por 13 meses, considerando-se o período entre a coleta e o final dos testes de germinação. É sugerido que ambas as espécies são potencialmente capazes de formar banco de sementes persistente no solo do Cerrado.

Storage in cerrado soil and germination of Psychotria vellosiana (Rubiaceae) seeds.

The regeneration of plant communities from seed depends, to a large extent, on the capacity of the seed remaining viable in the soil. The viability and germination of artificially buried Psychotria vellosiana seeds in cerrado soil were studied, with the purpose of discovering some physio-ecological aspects of dispersed seeds and evaluating their potential to constitute a soil seed bank. Seed samples were placed in nylon envelopes and buried in the soil of a Cerrado reserve at two different depths and sites. Buried seeds were retrieved periodically and tested for germination along with dry-stored seeds. In general, there was a reduction in seed germination with storage time, both in soil and dry stored conditions, and in some assays exhumed seeds germinated faster than dry stored ones. In general the soil storage favoured seed viability of ungerminated seeds as compared to dry stored ones, with the seeds remaining partially viable after 10 months of storage. The lack of germination of viable seeds suggests that seeds showed true dormancy and/or required an extended time to germinate. It was observed that some seeds had germinated while buried and such in situ germination tended to increase with rainfall. The water availability in the soil might be a limiting factor for successful germination of P. vellosiana in the field, and the seeds may constitute a persistent soil seed bank in the cerrado as dispersed seeds remain viable in the soil until the following period of seed dispersal.

Storage in cerrado soil and germination of Psychotria vellosiana (Rubiaceae) seeds

A regeneração de comunidades vegetais depende em grande parte da capacidade das sementes de se conservarem viáveis no solo. Estudou-se a viabilidade e germinação de sementes de Psychotria vellosiana manualmente enterradas no cerrado, com o objetivo de se conhecer alguns aspectos fisio-ecológicos de sementes dispersas, bem como seu potencial em formar banco de sementes no solo. Amostras de sementes foram colocadas em invólucros de tela de nylon e enterradas no solo do cerrado, em duas profundidades e em dois ambientes diferentes. As sementes enterradas eram periodicamente recuperadas e testadas quanto à sua germinação, juntamente com sementes armazenadas a seco. Em geral houve uma redução da germinação em função do tempo de armazenamento, seja no solo, seja na estocagem a seco, e em alguns ensaios as sementes exumadas germinaram mais rapidamente do que as armazenadas a seco. Em geral o armazenamento no solo favoreceu a viabilidade de sementes não germinadas, em comparação com as armazenadas a seco, e as sementes conservaram-se viáveis por mais de dez meses. A não germinação de sementes viáveis sugere a ocorrência de dormência e/ou a necessidade de um tempo maior de germinação. Constatou-se que parte das sementes germinou enquanto estavam enterradas, sendo maior a ocorrência no período mais chuvoso. A disponibilidade de água no solo pode ser um fator limitante para a germinação no campo de P. vellosiana, e as sementes podem constituir um banco de sementes persistente, já que sementes dispersas conservaram-se viáveis até o próximo período de dispersão.

Adult women with mitral valve prolapse are more flexible.

BACKGROUND: Mitral valve prolapse (MVP) is common in women. Other clinical features such as flexibility and hyperlaxity are often associated with MVP, as there is a common biochemical and histological basis for collagen tissue characteristics, range of joint motion, and mitral leaflet excursion. OBJECTIVE: To confirm whether adult women with MVP are more flexible and hypermobile than those without. METHODS: Data from 125 women (mean age 50 years), 31 of them with MVP, were retrospectively analysed with regard to clinical and kinanthropometric aspects. Passive joint motion was evaluated in 20 body movements using Flexitest and three laxity tests. Flexitest individual movements (0 to 4) and overall Flexindex scores were obtained in all subjects by the same investigator. RESULTS: Women with MVP were lighter, less endomorphic and mesomorphic, and more linear. The Flexindex was significantly higher in the women with MVP, both absolute (48 (1.6) v 41 (1.3); p<0.01) and centile for age (67 v 42; p<0.01) values. In 13 out of 20 movements, the Flexitest scores were significantly higher for the women with MVP. Signs of hyperlaxity were about five times more common in these women: 74% v 16% (p<0.01). Scores of 0 and 1 in elbow extension, absence of hyperlaxity, and a Flexindex centile below 65 were almost never found in women with MVP. CONCLUSION: Flexitest, alone or combined with hyperlaxity tests, may be useful in the assessment of adult women with MVP.