Comparison of distance covered, physiological cost, and perceived exertion in four six-minute walk test protocols.

Objective: There is evidence that indicates that the Walked Distance (WD) in the 6-Minute Walk Test (6MWT) would be sensitive to the type of track and encouragement. The aim of study was compared the impact of track type and verbal encouragement provided in the 6MWT on WD, physiological cost, perceived exertion, and gait efficiency in healthy young adults unfamiliar with the test. Method: WD, heart rate, subjective sensation of dyspnea (SSD), and fatigue (SSF) were measured in four 6MWT protocols: i) 30 m linear track and protocolized encouragement (LT + PE), ii) 30 m linear track and constant encouragement (LT + CE), iii) 81 m elliptical track and protocolized encouragement (ET + PE), and iv) 81 m elliptical track and constant encouragement (ET + CE). In addition, the Gait Efficiency Index (GIE) associated with physiological cost, dyspnea and fatigue was calculated and compared between the different protocols. Results: The WD was significantly higher in the ET + CE protocol. The percentage of the heart rate reserve used (%HRRu) at minute 6 was higher in the ET + CE protocol. The SSD and SSD had difference in startup time between the protocols. The GEI was higher in %HRRu, SSD, and SSF for the ET + CE protocol. Conclusion: The ET + CE protocol showed a significant increase in WD during the 6MWT in healthy young adults. Although it obtained the highest physiological cost, it did not present perceptual differences when entering cardiopulmonary assessment windows relevant to a more efficient test for the participant. It is advisable to discuss, based on the findings, the fundamental objective of the 6MWT and national and international recommendations to achieve a result as close as possible to the real maximal effort.

Effect of High-Intensity Interval Exercise versus Continuous Low-Intensity Aerobic Exercise with Blood Flow Restriction on Psychophysiological Responses: A Randomized Crossover Study.

This study compared the effect of continuous low-intensity aerobic exercise with blood flow restriction (LI-AE-BFR) versus high-intensity interval exercise (HIIE), matching total external mechanical work between conditions, on perceptual (exertion, pain, affective and pleasure) and physiological responses (heart rate [HR], blood lactate [BL] and muscle fatigue). Ten healthy untrained men (25.6 ± 3.78 years old; 75.02 ± 12.02 kg; 172.2 ± 6.76 cm; 24.95 ± 3.16 kg/m²) completed three visits to the laboratory. In visit 1, anthropometry, blood pressure and peak running velocity on the treadmill were measured. In visits 2 and 3, participants were randomly assigned to HIIE or LI-AE-BFR, both in treadmill. HIIE consisted of 10 one-minute stimuli at 80% of peak running velocity interspersed with one-minute of passive recovery. LI-AE-BFR consisted of 20-minutes of continuous walking at 40% of peak running velocity with bilateral cuffs inflated to 50% of arterial occlusion pressure. BL and maximum isometric voluntary contraction (MIVC - fatigue measure) were measured pre- and immediately post-exercise. HR, rating of perceived exertion (RPE), and rating of perceived pain (RPP) were recorded after each stimulus in HIIE and every two minutes in LI-AE-BFR. Affective response to the session, pleasure, and future intention to exercise (FIE) were assessed 10 minutes after the intervention ended. Increases in BL concentrations were greater in HIIE (p = 0.028; r = 0.51). No effects time or condition were reported for MIVC. HR was higher in HIIE at all analyzed time points (p < 0.001; d = 3.1 to 5.2). RPE did not differ between conditions (p > 0.05), while average session RPP was higher in LI-AE-BFR (p = 0.036; r = 0.46). Affective positive response (p = 0.019; d = 0.9) and FIE (p = 0.013; d = 0.97) were significantly higher in HIIE. Therefore, HIIE elicited higher physiological stress, positive affective response, and intention to engage in future exercise bouts compared to LI-AE-BFR.

Validity and reliability of SEIS-3: An instrument for subjective measuring of strength in older adults.

The use of rating of perceived exertion (RPE) has grown substantially, providing a valuable alternative for exercise intensity monitoring, especially for older adults. However, some challenges, such as cross-cultural validity, age-related differences, and reliability issues, necessitate the development of a concise and user-friendly RPE instrument, particularly for strength training in this population. This study aimed to validate the Subjective Effort Induction Scale (SEIS-3), a simplified tool for measuring effort during strength training. SEIS-3 is a graded instrument with three exertion levels: 1) Light effort, 2) Moderate effort, and 3) Strong effort. Twenty seniors, aged 71±7 years, of both genders participated in the study (CEP/Unimontes 2,741,071/2018). We collected maximal isometric voluntary contraction (MIVC) data using a digital dynamometer. Subsequently, participants underwent the initial test, following the three SEIS-3 categories in a randomly assigned order of induced subjective effort. SEIS-3 instrument was evaluated by the approaches:•Linear regression analysis: employed to assess the validity of the instrument.•Intraclass Correlation Coefficient (ICC): employed to assess the reliability of the instrument.SEIS-3 effort categories correlated with MIVC in both hands (R2=0.80, F = 25.596, df=3, p < 0.01 for right hand; R2=0.56, F = 9.132, p < 0.01 for left hand). Test-retest reliability for grip strength across effort categories was excellent (ICC > 0.9). SEIS-3 is a valid and reliable user-friendly tool for accurately assessing and regulating exercise intensity in older adults during strength tasks, benefiting their health, functional capacity, and overall quality of life. This low-cost instrument can help health professionals in their activities.

Efeitos do Treinamento Intervalado de Alta Intensidade e do Treinamento Contínuo na Capacidade de Exercício, Variabilidade da Frequência Cardíaca e em Corações Isolados em Ratos Diabéticos / Effects of High-Intensity Interval Training and Continuous Training on Exercise Capacity, Heart Rate Variability and Isolated Hearts in Diabetic Rats

Resumo Fundamento O treinamento intervalado de alta intensidade (HIIT) tem sido sugerido como alternativa ao treinamento contínuo (TC) em indivíduos com diabetes mellitus (DM) devido à sua curta duração e potencial para melhorar a adesão ao exercício. No entanto, dados sobre seu impacto sobre a variabilidade da frequência cardíaca (VFC) são escassos. Objetivos Avaliar e comparar os efeitos do HIIT e TC sobre a capacidade no exercício, VFC e corações isolados em ratos diabéticos. Métodos Animais diabéticos (estreptozotocina intravenosa, 45 mg.kg -1 ) e controles (C) realizaram 20 sessões de TC (5 dias/semana, 50 min, por quatro semanas) em esteira (70% da capacidade máxima de exercício) ou HIIT (ciclos de 1:1min a 50% e 90% da capacidade máxima de exercício). A VFC foi avaliada por eletrocardiograma contínuo, e a função cardíaca foi avaliada em corações isolados perfundidos. Para a análise dos dados, utilizamos a matriz do modelo linear generalizado de covariância multivariada ou o teste one-way ANOVA seguido pelo teste de Tukey, considerando um valor de p<0,05 como significativo. Resultados A capacidade de exercício (m/min) foi maior no grupo submetido ao HIIT [DM-HIIT: 36,5 (IIQ 30,0-41,3); C-HIIT: 41,5 (37,8-44,5), ambos n=10) em comparação ao grupo submetido ao TC [DM-TC: 29,0 (23,8-33,0); C-TC: 32,0 (29,5-37,0), ambos n=10) (p<0,001). A frequência cardíaca (bpm) foi mais baixa no grupo DM em comparação aos controles (p<0,001) tanto in vivo (DM-HIIT: 348±51, C-HIIT:441±66, DM-TC:361±70, C-TC:437±38) como nos corações isolados. Não houve diferenças na VFC entre os grupos. Os valores máximos e mínimos de dP/dt foram reduzidos no DM, com exceção da +dP/dt no grupo DM-HIIT vs. C-HIIT (diferença média: 595,5±250,3, p=0,190). Conclusão O HIIT de curto prazo promoveu melhora superior no desempenho no exercício em comparação ao TC, sem causar mudanças significativas na variabilidade da frequência cardíaca.

Abstract Background High-intensity interval training (HIIT) has been suggested as an alternative for continuous training (CT) in people with diabetes mellitus (DM) due to its short duration and potential to improve adherence to exercise. However, data on its impact on heart rate variability (HRV) are scarce. Objectives To assess and compare the effects of HIIT and CT on exercise capacity, HRV and isolated hearts in diabetic rats. Methods DM (intravenous streptozotocin, 45 mg.kg -1 ) and control (C) animals performed 20 sessions (5 days/week, 50 min, for 4 weeks) of CT on a treadmill (70% of maximal exercise capacity) or HIIT (cycles of 1:1min at 50% and 90% of maximal exercise capacity). HRV was assessed by continuous electrocardiogram, and cardiac function assessed in isolated perfused hearts. For data analysis, we used the framework of the multivariate covariance generalized linear model or one-way ANOVA followed by Tukey's test, considering p<0.05 as significant. Results Higher exercise capacity (m/min) was achieved in HIIT (DM-HIIT: 36.5 [IQR 30.0-41.3]; C-HIIT: 41.5 [37.8-44.5], both n=10) compared to CT (DM-CT: 29.0 [23.8-33.0]; C-CT: 32.0 [29.5-37.0], both n=10) (p<0.001). Heart rate (bpm) was lower in DM compared to controls (p<0.001) both in vivo (DM-HIIT:348±51, C-HIIT:441±66, DM-CT:361±70, C-CT:437±38) and in isolated hearts. There were no differences in HRV between the groups. Maximum and minimal dP/dt were reduced in DM, except +dP/dt in DM-HIIT vs. C-HIIT (mean difference: 595.5±250.3, p=0.190). Conclusion Short-term HIIT promotes greater improvement in exercise performance compared to CT, including in DM, without causing significant changes in HRV.

O Uso da Escala de Borg na Percepção do Esforço em Manobras de Reanimação Cardiopulmonar / The Use of the Borg Rating of Perceived Exertion Scale in Cardiopulmonary Resuscitation

Resumo Fundamento A parada cardiorrespiratória é um evento crítico cuja taxa de sobrevivência é relacionada à qualidade das manobras de reanimação, aliada à tecnologia. É importante compreender a percepção do cansaço durante esse procedimento visando a efetividade das compressões e o aumento das chances na sobrevida. Objetivo Aplicar a Escala de Borg para analisar o esforço percebido por enfermeiros durante as manobras de reanimação cardiopulmonar com dispositivo de feedback. Método Estudo experimental com distribuição randomizada de enfermeiros em hospital de ensino, simulando parada cardiorrespiratória, para avaliação da percepção do esforço utilizando a escala de Borg durante a reanimação cardiopulmonar com/sem dispositivo de feedback. Foi adotado nível de significância estatística 5%. Resultados Foram incluídos 69 enfermeiros atuantes em unidades críticas e não críticas de atendimento ao adulto. A percepção de esforço e a frequência cardíaca foi menor no grupo intervenção (p<0,001), influenciadas pelo dispositivo de feedback, sem diferença significativa quanto às unidades de atuação. Conclusão A escala de Borg mostrou-se adequada para os objetivos propostos. O dispositivo de feedback contribuiu no menor esforço e redução da frequência cardíaca durante as manobras de reanimação. O baixo custo e a facilidade de aplicação favorecem o uso em treinamentos e atendimentos em tempo real para avaliar o desempenho durante a reanimação, utilizando dispositivo de feedback por reduzir os esforços e a percepção do cansaço. Também permite a reflexão sobre os fatores intervenientes e recursos que podem influenciar na qualidade da assistência e nas chances de sobrevivência.

Abstract Background A cardiopulmonary arrest is a critical event whose survival rate is related to the quality of resuscitation maneuvers combined with the use of technology. It is important to understand the perception of fatigue during this procedure, aiming to improve the effectiveness of compressions to increase the chances of survival. Objectives To apply the Borg rating of perceived exertion scale (Borg scale) to analyze the exertion perceived by nurses during cardiopulmonary resuscitation maneuvers using a feedback device. Methods Experimental study with a randomized distribution of nurses in a teaching hospital. Perceived exertion during simulated cardiopulmonary resuscitation with/without a feedback device was assessed using the Borg scale. The statistical significance level of 5% was adopted. Results 69 nurses working in critical and non-critical adult care units were included. Perceived exertion and heart rate were lower in the intervention group (p<0.001), influenced by the feedback device, with no significant difference between critical and non-critical units. Conclusions The Borg scale proved to be adequate for the proposed objectives. The feedback device contributed to lower exertion and heart rate reduction during resuscitation maneuvers. The low cost and ease of application favor its use during training and real-time resuscitation attempts to assess performance using a feedback device to reduce exertion and perception of fatigue. It allows reflection on the intervening factors and resources that can influence the quality of resuscitation attempts and the chances of survival.

Respuesta fisiológica al test de lanzadera en pacientes candidatos a cirugía bariátrica / Physiologic response to the incremental shuttle walk test in candidates to undergo bariatric surgery / Resposta fisiológica ao teste incremental de caminhada em candidatos a cirurgia bariátrica

Objetivos: la valoración de la tolerancia al ejercicio es clave para prescribir ejercicio en candidatos a cirugía bariátrica. El test de lanzadera (TL) se ha propuesto para este objetivo. Sin embargo, la evidencia que describe el rendimiento y respuesta fisiológica asociados a esta prueba en dicha población es escasa. El objetivo de este estudio fue describir la respuesta fisiológica a la realización del TL en candidatos a cirugía bariátrica. Métodos: este estudio transversal incluyó a 56 participantes. Se midieron factores antropométricos como la edad, peso, estatura y circunferencia de cintura, así como el nivel de actividad física espontáneo. Se valoró el rendimiento en el TL en metros, la respuesta fisiológica asociada en términos de frecuencia cardiaca de reserva (FCR) utilizada, presión arterial sistólica y diastólica, oximetría de pulso, sensación subjetiva al esfuerzo (SSE) y de fatiga de extremidades inferiores, antes y después del TL. Resultados: todos los participantes completaron la prueba sin complicaciones. Caminaron una mediana de 465 metros, equivalente al 61% de la distancia esperada. Utilizaron un 56% de la FCR, mientras que la SSE y fatiga de extremidades inferiores alcanzó valores 7/10 y 6/10 respectivamente. Fueron observadas asociaciones significativas entre el rendimiento en el TL vs factores antropométricos e indicadores de respuesta fisiológica. Conclusión: el TL es una prueba segura para valorar la tolerancia al esfuerzo en candidatos a cirugía bariátrica, la cual induce respuestas fisiológicas asociadas a intensidades moderadas. Se sugiere incluir esta prueba para la valoración de la condición física de estos sujetos.

Objective: Exercise tolerance measurement is key for exercise prescription in bariatric surgery candidates. Thus, the incremental shuttle walking test (ISWT) has been proposed as a useful tool for this purpose. However, reports describing the performance, and related physiological response, in candidates to bariatric surgery are scarce. Therefore, the aim of this study was to describe the physiological response of bariatric surgery candidates to the ISWT. Methods: This cross-sectional study included 56 participants. Anthropometric factors such as age, weight, height, and waist circumference were measured, as well as their spontaneous physical activity levels. Their ISWT performance was recorded, as well as the percentage of heart rate reserve used during the test, systolic and diastolic pressure, pulse oximetry, perceived exertion scale, and lower extremities fatigue, both before and after the ISWT. Results: All participants completed the test without complications. They walked a median of 465 meters, 61% of the expected distance. Heart rate reserve utilization reached 56%, while the perceived exertion rate and lower extremities fatigue reached 7/10 and 6/10, respectively. Moreover, significant associations between the ISWT performance vs anthropometric factors and physiological response outcomes were found. Conclusion: The ISWT is a safe and useful tool to assess exercise tolerance in bariatric surgery candidates, which induces physiological responses associated to moderate effort intensities. We suggest including the ISWT when assessing the physical performance of bariatric surgery candidates.

Objetivo: A medida da tolerância ao exercício é fundamental para a prescrição do exercício em candidatos à cirurgia bariátrica. Assim, o teste incremental de caminhada em vaivém (ISWT) tem sido proposto como uma ferramenta útil para este fim. No entanto, são escassos os relatos que descrevem o desempenho e a resposta fisiológica relacionada em candidatos à cirurgia bariátrica. Portanto, o objetivo deste estudo foi describir a resposta fisiológica do ISWT em candidatos à cirurgia bariátrica. Métodos: Este estudo transversal incluiu 56 participantes. Fatores antropométricos como idade, peso, altura, circunferência da cintura foram medidos, assim como os níveis de atividade física espontânea. O desempenho do ISWT foi registrado, assim como a porcentagem de reserva de frequência cardíaca utilizada durante o teste, pressão sistólica e diastólica, oximetria de pulso, escala de esforço percebido e fadiga de membros inferiores, tanto antes quanto após o ISWT. Resultados: Todos os participantes completaram o teste sem intercorrências. Eles caminharam uma mediana de 465 metros, o equivalente a 61% da distância esperada. A utilização de reserva de frequência cardíaca atingiu 56%, enquanto a taxa de esforço percebido e fadiga de membros inferiores atingiram 7/10 e 6/10, respectivamente. Além disso, foram encontradas associações significativas entre o desempenho do ISWT versus fatores antropométricos e os resultados da resposta fisiológica. Conclusão: O ISWT é uma ferramenta segura e útil para avaliar a tolerância ao exercício em candidatos à cirurgia bariátrica, que induz respostas fisiológicas associadas a intensidades moderadas de esforço. Sugerimos incluir o ISWT para avaliar o desempenho físico dos candidatos à cirurgia bariátrica.

Musculoskeletal symptoms in formal and informal caregivers of elderly people / Sintomas musculoesqueléticos em cuidadores formais e informais de idosos / Síntomas musculoesqueléticos en cuidadores formales e informales de ancianos

ABSTRACT Objective: to evaluate musculoskeletal symptoms in formal and informal caregivers of elderly people, and check association with personal and work-related factors. Methods: this is a cross-sectional study. Instruments for assessment were the International Physical Activity Questionnaire, Self-Reporting Questionnaire-20, Borg's effort perception scale and Nordic Musculoskeletal Questionnaire. Results: informal caregivers had been working for a longer time (60.2% vs. 41%), had more hours of work (37.4% >12h for day), less time off (85.4% vs. 2.5%) and lack of care guidelines (90.2%). The region with the most musculoskeletal symptoms was the spine and the greater dependence of the elderly, the greater the chances of developing musculoskeletal symptoms (OR= 1.3, 95% CI= 1.1-1.6, p <0.05). Conclusion: personal and work-related factors were more prevalent in informal group and the elderly person's dependence interferes with the increase in musculoskeletal symptoms of caregivers.

RESUMO Objetivo: Avaliar sintomas musculoesqueléticos em cuidadores formais e informais de idosos e verificar a associação com fatores pessoais e relacionados ao trabalho. Método: Trata-se de um estudo transversal. Os instrumentos para avaliação foram o Questionário Internacional de Atividade Física (IPAQ), Self-Reporting Questionnaire-20, Escala de Percepção de Esforço de Borg e o Questionário Nórdico de Sintomas Musculoesqueléticos. Resultados: Cuidadores informais trabalhavam há mais tempo (60,2% vs. 41%), tinham mais horas de trabalho (37,4% >12 h por dia), menos tempo de folga (85,4% vs. 2,5%) e falta de orientações de cuidado (90,2%). A região com mais sintomas musculoesqueléticos foi a coluna vertebral; e, quanto maior a dependência dos idosos, maiores foram as chances de desenvolver sintomas musculoesqueléticos (OR= 1,3, 95% CI= 1,1-1,6, p <0,05). Conclusão: Fatores pessoais e relacionados ao trabalho foram mais prevalentes em cuidadores informais, e a dependência do idoso interferiu no aumento dos sintomas musculoesqueléticos dos cuidadores.

RESUMEN Objetivo: Evaluar los síntomas musculoesqueléticos en cuidadores formales e informales de los ancianos y verificar la asociación con factores personales y laborales. Métodos: Estudiotransversal. Los instrumentos para la evaluación fueron el Cuestionario Internacional de Actividad Física (IPAQ), Self-Reporting Questionnaire-20, Escala de Percepción del Esfuerzo de Borg y el Cuestionario Nórdico de Síntomas Musculoesqueléticos. Resultados: Los cuidadores informales trabajaron más tiempo (60,2% vs. 41%), tuvieron más horas de trabajo (37,4% >12h por día), menos tiempo libre (85,4% vs. 2,5%) y falta de pautas de atención (90,2%). La región con más síntomas musculoesqueléticos fue la columna vertebral y, cuanto mayor la dependencia de los ancianos, mayores son las posibilidades de desarrollar síntomas musculoesqueléticos (OR= 1.3, 95% CI= 1.1-1.6, p <0.05). Conclusión: Factores personales y relacionados con el trabajo fueron más frecuentes en los cuidadores informales y la dependencia de los ancianos interfiere con el aumento de los síntomas musculoesqueléticos en cuidadores.

Effectiveness of the contrast technique as recovery after effort according to professional athletes / Eficácia da técnica de contraste como recuperação pós-esforço segundo atletas profissionais

Abstract Introduction: Alterations caused in the metabolism of those who practice physical exercise regularly generate health benefits, however, in athletes, these alterations can cause muscle damage, so post-recovery recovery methods are extremely important for their physiological maintenance. Objective: To analyze the effectiveness of the contrast therapy technique with post-exercise recovery according to professional athletes. Methods: A questionnaire was applied that addressed the technical scientific knowledge of professional athletes over 18 years of age, of both sexes, about post-exerciseffort recovery techniques (PERT), personal information, and ethical issues, on an online platform. Descriptive statistical analysis was performed, with values presented in percentages and an association through the Chi-Square test on the knowledge of PERT and other independent variables. Results: In total, 63 athletes, 15 women and 48 men, answered the online questionnaire, 71.4% were between 18 and 30 years old, including swimmers, footballers, and athletics practitioners, and 85.7% had more than three years' experience in the sport and 57.1% competed at an international level. Considering the main PERTs, 92.1% were aware, 58.7% knew more than four, 96.8% frequently used at least one PERT, and 65.1% had used it for more than three years. Knowledge of PERTs is associated with age (p = 0.001), education (p = 0.001), practice time (p = 0.001), hours of daily training (0.001), and competitive level (p = 0.03). With respect to the use of the contrast technique, 36.5% of the respondents had already used it, and 34.9% found it effective. Conclusion: The athletes who used the contrast technique reported a good perception of recovery.

Resumo Introdução: Alterações causadas no metabolismo de quem pratica exercício físico constantemente geram benefícios à saúde. Em atletas, porém, causam danos musculares e por isso métodos de recuperação pós-esforço são de extrema importância para a manutenção fisiológica de atletas. Objetivo: Analisar a eficácia da técnica de contraste com recuperação pós-esforço segundo atletas profissionais. Métodos: Aplicou-se um questionário online que abordou o conhecimento técnico científico de atletas profissionais acima de 18 anos, de ambos os sexos, sobre técnicas de recuperação pós-esforço (TRPE), informações pessoais e questões éticas. Realizou-se análise estatística descritiva, onde os valores foram apresentados em percentuais, e associação através do teste qui-quadrado sobre o conhecimento das TRPE e demais variáveis independentes. Resultados: Responderam ao questionário online 63 atletas, 15 mulheres e 48 homens, sendo que 71,4% tinham entre 18 e 30 anos de idade. Estes eram nadadores, futebolistas e praticantes de atletismo; 85,7% possuíam experiência superior a três anos na modalidade e 57,1% competiam em nível internacional. Sobre as principais TRPE, 92,1% tinham conhecimento, 58,7% conheciam mais de quatro, 96,8% usavam com frequência ao menos uma TRPE e 65,1% utilizavam a mais de três anos. O conhecimento de TRPE está associado à idade (p = 0,001), escolaridade (p = 0,001), tempo de prática (p = 0,001), horas de treino diário (0,001) e nível competitivo (p = 0,03). Quanto ao uso da técnica de contraste, 36,5% dos respondentes já a haviam utilizado e, destes, 34,9% a consideram efetiva. Conclusão: Os atletas que utilizaram a técnica de contraste relataram boa percepção de recuperação.

Association of active behavior, body mass index, blood pressure and inflammatory cytokine in adolescents / Associação do comportamento ativo, índice de massa corporal, pressão arterial e citocinas inflamatórias em adolescentes

Abstract Introduction Physical inactivity is associated with obesity, chronic inflammation and the occurrence of chronic non-communicable diseases. Objective: To investigate the association of active behavior, body mass index (BMI), diastolic blood pressure (DBP) with serum levels of inflammatory interleukins in adolescents. Methods Cross-sectional population-based study of adolescents from public schools in São Luís, Maranhão. A theoretical model was built, based on Structural Equation Modeling, to explore the effects of the latent variable "active behavior" adjusted for socioeconomic status and gender, with effects on BMI, DBP and inflammatory load. Results Active behavior was associated with lower DBP values (standardized coefficient (SC) = -0.146; p = 0.029), while higher BMI was associated with higher DBP values (SC = 0.177; p < 0.001). For the highest values of active behavior there was a higher inflammatory load (SC = 0.442; p < 0.001); and a higher BMI was associated with a higher inflammatory burden (SC = 0.145; p = 0.025). Female gender had a higher inflammatory burden (SC = 0.282; p < 0.001). There was an indirect effect for females on lower inflammatory load values via reduction in active behavior (SC = -0.155; p < 0.001). Conclusion Active behavior reduces blood pressure levels in adolescents; while the increase in inflammatory cytokines induced by active behavior may be involved in their anti-inflammatory response for disease prevention.

Resumo Introdução A inatividade física está associada à obesidade, inflamação crônica e ocorrência de doenças crônicas não transmissíveis. Objetivo Investigar a associação do comportamento ativo, índice de massa corporal (IMC) e pressão arterial diastólica (PAD) com os níveis séricos de interleucinas inflamatórias em adolescentes. Métodos Estudo transversal de base populacional de adolescentes da rede pública de São Luís, Maranhão. Construiu-se um modelo teórico, baseado na Modelagem com Equações Estruturais, para explorar os efeitos da variável latente "comportamento ativo" ajustada para a situação socioeconômica e sexo com efeitos no IMC, PAD e carga inflamatória. Resultados O comportamento ativo foi associado aos menores valores de PAD (coeficiente padronizado (CP) = -0,146; p = 0,029), enquanto o maior IMC foi associado a maiores valores de PAD (CP = 0,177; p < 0,001). Para os maiores valores do comportamento ativo houve maior carga inflamatória (CP = 0,442; p < 0,001) e o maior IMC foi associado à maior carga inflamatória (CP = 0,145;p = 0,025). Sexo feminino teve maior carga inflamatória (CP = 0,282; p < 0,001). Houve um efeito indireto para o sexo feminino nos menores valores de carga inflamatória via redução do comportamento ativo (CP = -0,155; p < 0,001). Conclusão O comportamento ativo reduz os níveis pressóricos em adolescentes, enquanto o aumento das citocinas inflamatórias induzidas pelo comportamento ativo pode estar envolvido na sua resposta anti-inflamatória para a prevenção de doenças.

Cardiac Autonomic Modulation in Response to Muscle Fatigue and Sex Differences During Consecutive Competition Periods in Young Swimmers: A Longitudinal Study.

Objective: To study the differences in cardiac autonomic modulation in response to muscle fatigue caused by high-intensity exercise during two consecutive competition periods in young swimmers. Methods: Twenty-six competitive swimmers, selected by their training volume, were separated in two groups, females (n = 12 [46%], age: 13.5 ± 1.4 years) and males (n = 14 [54%], age: 13.9 ± 1.7 years), aged between 10 and 16 years, were evaluated five times as follow: (i) 21 days before the first competition (t-0); (ii) two days before (t-1; t-3); and (iii) two days after (t-2; t-4) of the first and second competitions. Morphological measurements (body mass, percentage of total body fat and height), blood pressure, power, and resting heart rate variability (RR with Polar band) were recorded before and after Wingate test at each time. Results: Body fat was higher in females compared to males. However, no differences were found in other morphological parameters. An intra-subject analysis grouped by sex in cardiovascular parameters shows longitudinal variations in systolic pressure and mean pressure among females. Additionally, females depicted higher, very low frequency (VLF, which is intrinsically generated by the heart and strongly associated with emotional stress) after physical fatigue compared to males at t-1. Further, before the competition, the high frequency (HF) component of HRV (parasympathetic drive) was higher in males than females at t-0 and t-4. Conclusion: Our data revealed that males displayed greater parasympathetic reactivity after an anaerobic muscle fatigue test during their competition periods. Contrarily, females had a less cardiac autonomic modulation when comparing the pre-post Wingate test after two consecutive competition periods.

Continuous Aerobic Training and High Intensity Interval Training Increase Exercise Tolerance in Heart Failure Patients: A Retrospective Study

Abstract Background: Conventional aerobic training is the first choice in cardiac rehabilitation for patients with chronic heart failure (CHF). However, high-intensity interval training (HIIT) may be an alternative, although it has little evidence. Objectives: To evaluate the effect of continuous aerobic training (CAT) or HIIT on exercise tolerance in CHF patients. Methods: Retrospective study with 30 patients, of both genders, members of a 10-week CAT or HIIT program. The control group (CON) consisted of patients who did not participate voluntarily in the program. Peak oxygen uptake (VO2peak), thresholds (LV1 and LV2), and ventilatory efficiency in the production of dioxide (VE/VCO2 slope), oxygen uptake efficiency (OUES), and VO2 recovery kinetics were analyzed. A two-way or repeated measures ANOVA was used, followed by Fisher's post-hoc test (p<0.05). Results: After 10 weeks of training, the CAT group increased the treadmill speed at LV1 (p=0.040), while the HIIT increased both the speed (p=0.030) and incline of the treadmill (p<0.001) for VO2peak and LV2, as well as the total time of the cardiopulmonary test. The VE/VCO2 slope was lower than that predicted for CAT (p=0.003) and HIIT (p=0.008). There was no change in VO2peak, recovery of heart rate (HR), and VO2, VE/VCO2, and OUES in both groups. Conclusions: After 10 weeks, both CAT and HIIT increased the tolerance to physical exercise. However, HIIT showed improvement in more parameters, differently from CAT.

Fatal sickling-associated microvascular occlusive crisis in a young with sickle cell trait.

Sickle cell trait (SCT), a heterozygous state characterized by hemoglobin AS, occurs commonly in sub-Saharan Africa, South America, Central America, India, and the Mediterranean countries. SCT is compatible with a normal lifespan and is not commonly regarded as a cause of morbid illness or death compared to its homozygous counterpart. We describe a case of fatal sickling-associated microvascular crisis, identified on post mortem evaluation in a previously undiagnosed 21-year-old military recruit with sickle cell trait. The individual presented with repeated syncope episodes during his training and was autopsied in the pursuit of cardiac anomalies and heat syncope. During the terminal episode, he collapsed and died of severe metabolic complications as he struggled to complete an organized run during routine training activities. To our knowledge, this is the first report of fatal sickling-associated crisis in a military recruit with sickle cell trait from India. This case serves to remind all armed forces and sports physicians of the importance of screening a recruit who is unable to complete exertional physical training for the presence of sickle cell trait.

Efectos de un programa de ejercicio neuromuscular en la condición física del adulto mayor de la comunidad: ensayo clínico aleatorizado en grupos paralelos y ciego doble / Effects of a neuromuscular exercise program on the physical condition of the older adult in the community: randomized clinical trial in parallel groups and double blind

OBJETIVO: Comparar los efectos de un programa de ejercicio neuromuscular (ENM) respecto a un programa de ejercicio municipal (EM) sobre la condición física en adultos mayores de la comunidad. Metodología: Ensayo clínico aleatorizado en grupos paralelos y ciego doble. Muestra constituida por 82 sujetos, edad X = 72 años (DE = +/-5 años) pertenecientes a la Casa del Adulto Mayor de la ciudad de Talca. La selección fue de manera no probabilística por conveniencia, la asignación a los grupos mediante aleatorización estratificada y el ocultamiento de la asignación por medio de sobres cerrados. El cegamiento doble fue para los participantes y los evaluadores. Ambos grupos realizaron ejercicio en paralelo durante seis meses, tres veces a la semana. Las comparaciones inter-grupo de la condición física fueron analizados por medio de ANOVA multivariante de un factor. En todos los casos se adoptó un p < 0.05 y se utilizó SPSS 25.Resultados: Los sujetos del grupo ENM lograron significativamente un mejor rendimiento en todas las variables de condición física respecto al grupo EM (p < 0.05). Conclusión: El ENM mejoró significativamente la condición física de adultos mayores de la comunidad respecto a la aplicación de un programa de ejercicio municipal.

OBJECTIVE: To compare the effects of a neuromuscular exercise program (ENM) with respect to a municipal exercise program (EM) on the physical condition of older adults in the community. Methodology: Double blind, parallel group randomized clinical trial. Sample made up of 82 subjects, age X = 72 years (SD = +/- 5 years) belonging to the House for the Elderly in the city of Talca. Selection was non-probabilistic for convenience, group assignment by stratified randomization, and allocation concealment by sealed envelopes. Double blinding was for participants and assessors. Both groups exercised in parallel for 6 months, 3 times a week. The inter-group comparisons of physical condition were by means of one-way multivariate ANOVA. In all cases a p <0.05 was adopted and SPSS 25 was used. Results: The subjects of the ENM group achieved significantly better performance in all the physical condition variables compared to the EM group (p <0.05). Conclusion: The ENM significantly improved the physical condition of older adults in the community with respect to the application of a municipal exercise program.

Fatal sickling-associated microvascular occlusive crisis in a young with sickle cell trait

Sickle cell trait (SCT), a heterozygous state characterized by hemoglobin AS, occurs commonly in sub-Saharan Africa, South America, Central America, India, and the Mediterranean countries. SCT is compatible with a normal lifespan and is not commonly regarded as a cause of morbid illness or death compared to its homozygous counterpart. We describe a case of fatal sickling-associated microvascular crisis, identified on post mortem evaluation in a previously undiagnosed 21-year-old military recruit with sickle cell trait. The individual presented with repeated syncope episodes during his training and was autopsied in the pursuit of cardiac anomalies and heat syncope. During the terminal episode, he collapsed and died of severe metabolic complications as he struggled to complete an organized run during routine training activities. To our knowledge, this is the first report of fatal sickling-associated crisis in a military recruit with sickle cell trait from India. This case serves to remind all armed forces and sports physicians of the importance of screening a recruit who is unable to complete exertional physical training for the presence of sickle cell trait.

Endothelial nitric oxide concentrations in the saliva of jiu-jitsu athletes / Concentrações de óxido nítrico endotelial na saliva de atletas de jiu-jitsu / Concentraciones de óxido nítrico endotelial en la saliva de atletas de jiu-jitsu

ABSTRACT Introduction This article discusses the production of nitric oxide under the influence of sport-specific physical training, measured by the salivary nitrite of Jiu-Jitsu athletes. Objectives To verify the potential of the sport to produce optimal levels of nitric oxide stimulated by exertion, and to quantify training-related nitric oxide concentrations. Method The study participants were 14 volunteer athletes from the Tatame project (extension project), who were monitored for nine months in their training routine, providing samples of unstimulated saliva. Samples were collected each month, in three periods of the day: in the morning upon waking, immediately before training, and immediately after training. Salivary nitrite was quantified by the colorimetric Griess assay. Training heart rates were also monitored in order to establish training intensity. Results Mean monthly salivary nitrite levels showed a significant correlation with mean monthly heart rates, suggesting that salivary nitrite responds to training. However, salivary nitrite concentrations measured immediately after training were always lower than in the pre-training period. Conclusion The post-training reduction in concentrations was due to the nature of the sport studied, since because it involves a fight, the intense sympathetic stimulation inhibited salivary gland activity and irrigation, preventing salivary nitrite from producing an increase in circulating nitric oxide. Level of evidence IV; Case series.

RESUMO Introdução Este artigo discute a produção de óxido nítrico sob interferência do treinamento físico esportivo, medida pelo nitrito salivar em atletas de Jiu-Jitsu. Objetivos Verificar as potencialidades da modalidade na produção de níveis ideais de óxido nítrico estimulado pelo esforço e quantificar as concentrações de óxido nítrico relacionadas com o treinamento. Métodos O estudo teve a participação de 14 atletas voluntários do Projeto Tatame (projeto de extensão), que foram acompanhados por nove meses em sua rotina de treinamento e forneceram amostras de saliva não estimulada. Foram coletadas amostras a cada mês, em três períodos do dia: pela manhã ao acordar, imediatamente antes do treino e imediatamente após o treino. O nitrito salivar foi quantificado pelo método colorimétrico de Griess. Também foram monitoradas as frequências cardíacas de treinamento a fim de se estabelecer a intensidade do treinamento realizado. Resultados As médias mensais de nitrito salivar demonstraram correlação significativa com as médias mensais de frequência cardíaca, dando indícios de que o nitrito salivar responde ao treinamento. Contudo, as concentrações de nitrito salivar medidas imediatamente após o treinamento sempre eram menores com relação ao período anterior do treino. Conclusão A redução da concentração depois do treinamento deveu-se à natureza da modalidade estudada, visto que, por ser uma luta, a forte carga de estimulação simpática inibiu a atividade das glândulas salivares, bem como sua irrigação, impedindo que o nitrito salivar produzisse aumento do óxido nítrico circulante. Nível de evidência IV; Série de casos.

RESUMEN Introducción Este artículo analiza la producción de óxido nítrico bajo la influencia del entrenamiento físico deportivo, medida por el nitrito salival de atletas de Jiu-Jitsu. Objetivos Verificar el potencial de la modalidad en la producción de niveles ideales de óxido nítrico estimulado por el esfuerzo y cuantificar las concentraciones de óxido nítrico relacionadas con el entrenamiento. Métodos El estudio contó con la participación de 14 atletas voluntarios participantes del Proyecto Tatame (proyecto de extensión) a quienes se les dio seguimiento durante nueve meses en su rutina de entrenamiento y proporcionaron muestras de saliva no estimulada. Se recolectaron muestras cada mes, en tres períodos del día: en la mañana al despertar, inmediatamente antes del entrenamiento e inmediatamente después del entrenamiento. El nitrito salival se cuantific ó por el método colorimétrico de Griess. Las frecuencias cardíacas de entrenamiento se monitorearon para establecer la intensidad del entrenamiento realizado. Resultados Los promedios mensuales de nitrito salival mostraron una correlación significativa con los promedios mensuales de frecuencia cardíaca, lo que indica que el nitrito salival responde al entrenamiento. Sin embargo, las concentraciones de nitrito salival medidas inmediatamente después del entrenamiento siempre fueron más bajas en comparación con el período anterior al entrenamiento. Conclusión La reducción de la concentración después del entrenamiento se debió a la naturaleza de la modalidad estudiada, ya que, por ser una lucha, la fuerte carga de estimulación simpática inhibió la actividad de las glándulas salivales, así como su irrigación, evitando que el nitrito salival produjera aumento de óxido nítrico circulante. Nivel de evidencia IV; Serie de casos.

Cumplimiento de las recomendaciones de actividad física de la OMS por usuarios de bicicletas públicas en un municipio español / Compliance with the recommendations for physical activity set by the WHO by public bicycle users in a Spanish municipality

Introducción: Uno de los grandes retos de la sociedad es combatir el sedentarismo para prevenir la aparición de enfermedades y problemas cardiovasculares asociados a la inactividad física. Los sistemas de bicicletas públicos son una alternativa sostenible y equitativa que se ofrece desde las distintas instituciones para paliar, en cierta forma, los bajos niveles de actividad física, reducir los niveles de contaminación de las ciudades y los problemas de tráfico a motor. Objetivo: Conocer si los usuarios del sistema público de bicicletas compartidas de Vilagarcía de Arousa (España) cumplen con las recomendaciones de actividad física para la salud establecidas por la OMS. Material y Métodos: En este estudio de corte longitudinal se realiza un análisis del uso de las bicicletas compartidas en un municipio del noroeste de España para comprobar si alcanzan las recomendaciones mínimas de actividad física para la salud marcadas por la OMS en el año 2010. Se utilizó el programa informático SPSS para realizar los cálculos estadísticos. La muestra estuvo compuesta por un total de 3268 usuarios del servicio de bicicletas compartidas y se contabilizó un total de 84183 usos desde el 17 de julio de 2009 hasta el 18 de enero de 2012. Resultados: Los resultados indican que los usuarios del sistema Vaibike de Vilagarcía de Arousa cumplen las recomendaciones mínimas de actividad física dado que la media de minutos de uso de las bicicletas es superior a 30 minutos. Conclusiones: Los trayectos que han tenido más media de minutos de uso de las bicicletas del sistema han sido los correspondientes con el centro y los que transcurren por la costa de la ciudad, superando los 30 minutos de uso y cumpliendo las recomendaciones marcadas por la OMS en el año 2010(AU)

Introduction: One of the great challenges of society is to fight sedentary lifestyle to prevent the onset of cardiovascular diseases and problems associated with physical inactivity. Public bicycle systems are a sustainable and equitable alternative offered by different institutions to alleviate low levels of physical activity and to reduce pollution in cities and motor traffic problems. Objective: To know if the users of the public bicycle sharing system of Vilagarcía de Arousa (Spain) comply with the recommendations of physical activity for health established by the WHO. Material and Methods: In this longitudinal section study, an analysis of the use of shared bicycles in a municipality in northwestern Spain was carried out, checking whether the minimum physical activity recommendations for health set by the WHO in 2010 were reached. The SPSS software was used to perform the statistical calculations. The sample consisted of a total of 3268 users of the shared bicycle service and a total of 84183 uses were counted from July 17, 2009 to January 18, 2012. Results: The results indicate that users of the Vaibikebicycle sharing system of Vilagarcía de Arousa comply with the minimum recommendations of physical activity given that the average number of minutes of use of bicycles is greater than 30 minutes. Conclusions: The routes that have had more minutes of use of thebicyclesof the systemhave been those corresponding to the center and those that run along the coast of the city, exceeding 30 minutes of use and complying with the recommendations set by the WHO in 2010(AU)

Intensidade de Exercício durante o Teste de Caminhada de 6 Minutos em Pacientes com Doença Arterial Periférica / Exercise Intensity during 6-Minute Walk Test in Patients with Peripheral Artery Disease

Resumo Fundamento a caminhada não supervisionada em solo tem sido indicada para pacientes com doença arterial periférica (DAP) sintomática. No entanto, a magnitude do esforço exigido por essa atividade e as características dos pacientes que a praticam com mais intensidade não estão claras. Objetivos determinar se a caminhada em solo excede o limiar ventilatório (LV), um reconhecido marcador de intensidade de exercício, em pacientes com DAP sintomática. Métodos Foram recrutados 70 pacientes (61,4% do sexo masculino e com idade entre 40 e 85 anos) com DAP sintomática. Os pacientes realizaram um teste ergométrico em esteira para definir o LV. Em seguida, foram submetidos ao teste de caminhada de 6 minutos para determinar o alcance do LV durante deambulação no solo. Realizou-se regressão logística múltipla para identificar preditores de LV durante o teste de caminhada de 6 minutos, e o valor de p<0,05 foi considerado significativo para todas as análises. Resultados Ao todo, 60% dos pacientes atingiram o LV durante o teste de caminhada de 6 minutos. Mulheres (OR = 0,18 e IC95% = 0,05 a 0,64) e pacientes com mais aptidão cardiorrespiratória (OR = 0,56 e IC 95% = 0,40 a 0,77) tiveram menor probabilidade de chegar ao LV durante a caminhada em solo em comparação a homens e pacientes com menos aptidão cardiorrespiratória, respectivamente. Conclusão Mais da metade dos pacientes com DAP sintomática alcançou o LV durante o teste de caminhada de 6 minutos. Mulheres e pacientes com mais aptidão cardiorrespiratória têm menos probabilidade de chegar ao LV durante o teste de caminhada de 6 minutos, o que indica que a caminhada no solo pode ser mais intensa para esse grupo. Isso deve ser considerado ao se prescreverem exercícios de caminhada em solo para esses pacientes. (Arq Bras Cardiol. 2020; 114(3):486-492)

Abstract Background Non-supervised ground walking has been recommended for patients with symptomatic peripheral artery disease (PAD). However, the magnitude of the effort required by this activity and the characteristics of patients whose ground walking is more intense are unclear. Objectives To determine whether ground walking exceeds the ventilatory threshold (VT), a recognized marker of exercise intensity, in patients with symptomatic PAD. Methods Seventy patients (61.4% male and aged 40 to 85 years old) with symptomatic PAD were recruited. Patients performed a graded treadmill test for VT determination. Then, they were submitted to a 6-minute walk test so the achievement of VT during ground ambulation could be identified. Multiple logistic regression was conducted to identify predictors of VT achievement during the 6-minute walk test. The significance level was set at p < 0.05 for all analyses. Results Sixty percent of patients achieved VT during the 6-minute walk test. Women (OR = 0.18 and 95%CI = 0.05 to 0.64) and patients with higher cardiorespiratory fitness (OR = 0.56 and 95%CI = 0.40 to 0.77) were less likely to achieve VT during ground walking compared to men and patients with lower cardiorespiratory fitness, respectively. Conclusion More than half of patients with symptomatic PAD achieved VT during the 6-minute walk test. Women and patients with higher cardiorespiratory fitness are less likely to achieve VT during the 6-minute walk test, which indicates that ground walking may be more intense for this group. This should be considered when prescribing ground walking exercise for these patients. (Arq Bras Cardiol. 2020; 114(3):486-492)