Ana Inês Gonzáles

Prevalence of Overweight and Obesity in Children and Adolescents from the Age Range of 2 to 19 Years Old in Brazil

Introduction. Infant juvenile obesity is currently a worldwide public health problem and it is increasing at alarming rate in the Brazilian population, showing its relevance in terms of public health. Objectives. Determine the prevalence of overweight and obesity in children and adolescents between 2 and 19 years old in different regions of Brazil. Methods. The following electronic databases were searched (from September through November 2013): Medline (PubMed), LILACS, and SciELO, using the descriptors and Boolean operators (obesity) and (overweight) and (child) and (prevalence) and (Brazil). Prospective and/or cross-sectional designs studies were found regarding the prevalence of overweight and obese children and adolescents in the five regions of Brazil. Results. A total of 191 scientific articles were found of which 17 met all inclusion criteria. A higher prevalence of overweight was found in the south (25.7%) and north (28.8%) of the country, and obesity in the southeast (15.4%) and south (10.4%). Conclusions. The scope of the studies was mostly based on municipal coverage, which resulted in limitations for conclusive analysis, showing the need for further studies of prevalence at the national level, with emphasis on public health in obese children and adolescents throughout the Brazilian territory.

Validation of the International Index of Erectile Function (IIFE) for use in Brazil.

Background The International Index of Erectile Function has been proposed as a method for assessing sexual function assisting the diagnosis and classification of erectile dysfunction. However, IIEF was not validated for the Portuguese language. Objective Validate the International Index of Erectile Function in patients with cardiopulmonary and metabolic diseases. Methods The sample consisted of 108 participants of to Cardiopulmonary and Metabolic program Rehabilitation (CPMR) in southern Brazil. The clarity assessment of the instrument was performed using a scale ranging from zero to 10. The construct validity was carried out by confirmatory factor analysis (KMO = 0.85; Barllet p < 0.001), internal consistency by Cronbachs alpha and reproducibility and interrater reliability via the test retest method. Results The items were considered very clear with averages superior to 9. The internal consistency resulted in 0.89. The majority of items related correctly with their domains, with exception of three questions from sexual satisfaction domain, and one from erectile function. All items showed excellent stability of measure and substantial to almost perfect agreement. Conclusion The present study showed that the IIEF is valid and reliable for use in participants of a cardiopulmonary and metabolic rehabilitation program.

Questionário nutricional simplificado de apetite (QNSA) para uso em programas de reabilitação cardiopulmonar e metabólica

This study aimed to translate and validate a Brazilian version of the Simplified Nutritional Appetite Questionnaire (SNAQ), checking its clarity and validity for the participants of the Cardiopulmonary and Metabolic Rehabilitation Program (CPMR). One hundred and forty-six subjects were interviewed: 79 males, mean age of 63 years (±10) and 67 women, mean age of 66 years (±11). Descriptive analysis was presented as mean, standard deviation and frequency. The internal consistency of the scale was assessed using Cronbachs alpha coefficient and factor analysis by the method of extraction of principal components analysis using Kaisers criteria (eigenvalues > 1). All questions of the instrument showed positive results regarding clarity. The questionnaire items presented factor loadings above 0.40, (ranging from 0.40 to 0.81). Except for the issue related to the amount of daily meals, all others showed high correlation with the total score of the Brazilian version. Regarding the analysis of internal consistency, the result of 0.61 was reached. In conclusion, the Brazilian Version of SNAQ proved to be valid for use in CPMR program participants, thus becoming an important tool in assessing the appetite of the Brazilian population.

Noninvasive ventilation and exercise tolerance in heart failure: A systematic review and meta-analysis

Background: Patients with heart failure (HF) usually develop exercise intolerance. In this context, noninvasive ventilation (NIV) can help to increase physical performance. Objective: To undertake a systematic review and meta-analysis of randomized controlled trials that evaluated the effects of NIV on exercise tolerance in patients with HF. Method: Search Strategy: Articles were searched in the following databases: Physiotherapy Evidence Database (PEDro), Scientific Electronic Library Online (SciELO), and MEDLINE. Selection Criteria: This review included only randomized controlled trials involving patients with HF undergoing NIV, with or without other therapies, that used exercise tolerance as an outcome, verified by the distance travelled in the six-minute walk test (6MWT), VO2peak in the cardiopulmonary test, time spent in testing, and dyspnea. Data Collection and Analysis: The methodological quality of the studies was rated according to the PEDro scale. Data were pooled in fixed-effect meta-analysis whenever possible. Results: Four studies were selected. A meta-analysis including 18 participants showed that the use of NIV prior to the 6MWT promoted increased distance, [mean difference 65.29 m (95% CI 38.80 to 91.78)]. Conclusions: The use of NIV prior to the 6MWT in patients with HF may promote increased distance. However, the limited number of studies may have compromised a more definitive conclusion on the subject.

Protocolo de samba brasileiro para reabilitação cardíaca

Introduccion:Samba es una danza de movimientos intensos y variados que traen alegria y buena respuesta cronotropica, y es plausible esperar que beneficia el sistema cardiovascular.Objetivo:Desarrollar y evaluar un proto-colo de samba brasileno destinado a entrenamiento fisico en la rehabilitacion cardiaca.Metodos:Quince pacientes con enfermedad coronaria estable, edad 60,74 ± 5,96 anos, fueron sometidos a prueba de esfuerzo cardiopulmonar maximo para determinar la frecuencia cardiaca (FC) correspondiente a VO2pico y primer y segundo umbrales ventila-torios. Durante seis sesiones realizaron veinte pasos de samba, en tres movimientos musicales clasificados en orden de metronomo a lento, medio o rapido. Posteriormente se realizaron tres sesiones para comprobar el comportamiento de la FC y el esfuerzo percibido. Se realizo un analisis descriptivo para la caracterizacion de la muestra y la verificacion de la FC; se utilizaron la prueba t o prueba de Wilcoxon para comparar el comportamiento de la FC (en diferentes sesiones), con un nivel de significacion del 5%.Resultados:Hubo una buena adaptacion a los pasos de samba, com la FC entre el 62% y el 72% de FCpico. Durante las sesiones de baile, los pacientes se mantuvieron en 86 ± 4,17% del tiempo en la zona de destino propuesta para el entrenamiento fisico en rehabilitacion (60% a 90% de FCpico) y 77 ± 2,26% del tiempo en la zona de destino considerado optimo, con la FC situada entre el primero y el segundo umbral ventilatorio. Todo el tiempo la percepcion percibida pelos pacientes fue de esfuerzos leves a moderados.Conclusion:Los pacientes mostraron una buena adaptacion al protocolo de samba, que resulto en condiciones de ser adoptado como una propuesta para el entrenamiento en rehabilitacion cardiaca.

Validation of the Brunel mood scale for cardiac rehabilitation program

Introdução: Os programas de reabilitação cardiopulmonar e metabólica (RCPM) vêm adotando protocolos de treinamento físico que valorizam o volume e a alta intensidade, sendo possível o aparecimento da síndrome do excesso de treinamento (SET). Neste contexto, o uso sistemático de instrumentos para investigação do estado de humor pode auxiliar na detecção precoce da SET. Objetivo: Validar a escala de Humor de Brunel (BRUMS) em participantes de RCPM. Métodos: Fizeram parte do estudo 247 indivíduos, com média de idade de 63,3±10,5 anos, participantes há pelo menos três meses de programa de RCPM. A análise descritiva foi apresentada em média, desvio padrão e distribuição de frequência. Para avaliar a validade de construto foi utilizada a análise fatorial confirmatória. Para verificar a adequação dos dados foi utilizado o índice de Kaiser-Meyer-Olkin (KMO). Para interpretação da matriz, foi aplicado o método de extração dos componentes principais, por meio do método varimax. A consistência foi avaliada por meio do coeficiente alfa de Cronbach. Resultados: Todas as questões do BRUMS obtiveram médias superiores a nove, demonstrando que as questões do instrumento foram julgadas muito claras pelos participantes. Foi verificado que 83,3% das questões relacionaram-se corretamente com seus respectivos domínios. No que se refere à análise de consistência interna, todos os domínios apresentaram valor acima de 0,6. Conclusão: A Escala de Humor de Brunel é válida para pacientes que participam de programa de reabilitação cardiopulmonar e metabólica.INTRODUCCION: Los programas de rehabilitacion cardiopulmonar y metabolica (RCPM) han adoptado protocolos para el entrenamiento fisico que valoran alto volumen y alta intensidad, con la posible aparicion del sindrome de sobreentrenamiento (SET). En este contexto, el uso sistematico de herramientas investigativas del estado de animo puede ayudar a la deteccion temprana del SET.OBJETIVO: Validar la Escala de Humor de Brunel (BRUMS) en participantes del RCPM.METODOS: Los participantes fueron 247 personas con una edad media de 63,3 ± 10,5 anos, involucrados en el programa de RCPM por lo menos tres meses. El analisis descriptivo se presenta como media, desviacion estandar y distribucion de frecuencias. Para evaluar la validez de constructo se utilizo el analisis factorial confirmatorio. Para verificar la idoneidad de los datos, se utilizo el indice de Kaiser-Meyer-Olkin (KMO). Para interpretar la matriz, se aplico el metodo de extraccion de los componentes principales, utilizando el metodo varimax. La consistencia se evaluo mediante el coeficiente alfa de Cronbach.RESULTADOS: Todos los temas del BRUMS obtuvieron promedios superiores a nueve, lo que demuestra que las preguntas del instrumento fueron juzgadas muy claras por los participantes. Se encontro que 83,3% de las preguntas estaban correctamente relacionadas con sus respectivos dominios. En cuanto al analisis de consistencia interna, todos los dominios presentaron valor superior a 0,6.CONCLUSION: La Escala de Humor de Brunel es valida para los pacientes que participan en un programa de rehabilitacion cardiopulmonar y metabolica.

Validação da escala de humor de Brunel para programa de reabilitação cardiovascular

Introdução: Os programas de reabilitação cardiopulmonar e metabólica (RCPM) vêm adotando protocolos de treinamento físico que valorizam o volume e a alta intensidade, sendo possível o aparecimento da síndrome do excesso de treinamento (SET). Neste contexto, o uso sistemático de instrumentos para investigação do estado de humor pode auxiliar na detecção precoce da SET. Objetivo: Validar a escala de Humor de Brunel (BRUMS) em participantes de RCPM. Métodos: Fizeram parte do estudo 247 indivíduos, com média de idade de 63,3±10,5 anos, participantes há pelo menos três meses de programa de RCPM. A análise descritiva foi apresentada em média, desvio padrão e distribuição de frequência. Para avaliar a validade de construto foi utilizada a análise fatorial confirmatória. Para verificar a adequação dos dados foi utilizado o índice de Kaiser-Meyer-Olkin (KMO). Para interpretação da matriz, foi aplicado o método de extração dos componentes principais, por meio do método varimax. A consistência foi avaliada por meio do coeficiente alfa de Cronbach. Resultados: Todas as questões do BRUMS obtiveram médias superiores a nove, demonstrando que as questões do instrumento foram julgadas muito claras pelos participantes. Foi verificado que 83,3% das questões relacionaram-se corretamente com seus respectivos domínios. No que se refere à análise de consistência interna, todos os domínios apresentaram valor acima de 0,6. Conclusão: A Escala de Humor de Brunel é válida para pacientes que participam de programa de reabilitação cardiopulmonar e metabólica.INTRODUCCION: Los programas de rehabilitacion cardiopulmonar y metabolica (RCPM) han adoptado protocolos para el entrenamiento fisico que valoran alto volumen y alta intensidad, con la posible aparicion del sindrome de sobreentrenamiento (SET). En este contexto, el uso sistematico de herramientas investigativas del estado de animo puede ayudar a la deteccion temprana del SET.OBJETIVO: Validar la Escala de Humor de Brunel (BRUMS) en participantes del RCPM.METODOS: Los participantes fueron 247 personas con una edad media de 63,3 ± 10,5 anos, involucrados en el programa de RCPM por lo menos tres meses. El analisis descriptivo se presenta como media, desviacion estandar y distribucion de frecuencias. Para evaluar la validez de constructo se utilizo el analisis factorial confirmatorio. Para verificar la idoneidad de los datos, se utilizo el indice de Kaiser-Meyer-Olkin (KMO). Para interpretar la matriz, se aplico el metodo de extraccion de los componentes principales, utilizando el metodo varimax. La consistencia se evaluo mediante el coeficiente alfa de Cronbach.RESULTADOS: Todos los temas del BRUMS obtuvieron promedios superiores a nueve, lo que demuestra que las preguntas del instrumento fueron juzgadas muy claras por los participantes. Se encontro que 83,3% de las preguntas estaban correctamente relacionadas con sus respectivos dominios. En cuanto al analisis de consistencia interna, todos los dominios presentaron valor superior a 0,6.CONCLUSION: La Escala de Humor de Brunel es valida para los pacientes que participan en un programa de rehabilitacion cardiopulmonar y metabolica.

Cardiovascular rehabilitation, ballroom dancing and sexual dysfunction.

Sexual dysfunction is an important public health concern, highly prevalent among men and women1,2. It is related to the major cardiovascular and metabolic diseases eligible for cardiopulmonary and metabolic rehabilitation (CPMR), such as systemic arterial hypertension, coronary arterial disease, heart failure, and diabetes mellitus3,4. Of the vascular, structural and functional abnormalities related to sexual dysfunction, the following stand out: endothelial changes; systolic pressure elevation; and atherosclerosis5. Sexual function is a good parameter to assess the treatment of cardiovascular diseases, known to improve the quality of life of patients6, most of whom show interest in maintaining an active sexual life. Nevertheless, the manifestations of sexuality are usually underestimated by physicians and other health care professionals, in part due to cultural aspects, taboos and prejudice7. That should change, because, after a cardiovascular event or intervention, the instructions about sexual activity are as relevant as those concerning return to work and engagement into exercise programs8. The complexity of that relationship and the need for instructions have become evident in studies, such as the COPE-ICD, which reported, contrary to the expected, expressive sexual function worsening in patients of both sexes who underwent defibrillator implantation8. Historically, the medicamentous treatment of cardiovascular diseases has been associated with worse sexual performance5,9,10. However, the new generation medications, such as modern beta-blockers (nebivolol and bisoprolol), diuretics (indapamide) and angiotensin-receptor blockers, seem to contribute to improve erectile dysfunction, especially by improving endothelial function and increasing cardiac fitness10,11, enabling the simultaneous treatment of sexual dysfunction. Sexual function is mediated by a complex interaction of psychological and physiological factors (hormonal, vascular, muscular and neurological), which might all be influenced by exercise3, emphasis given to the greater production and lower degradation of nitric oxide, considered the major mediator of male and female sexual function12. It is worth noting that research related to exercise and sexual function has shown that high doses of physical activity reduce the risk of acute myocardial infarction and sudden death during sexual intercourse13. In addition, among young men, those with better cardiorespiratory fitness are less susceptible to erectile dysfunction14. Thus, it is evident that physical exercise should be included among the interventions that benefit cardiovascular and sexual health11. The effects of exercise on physical fitness, endothelial function, autonomic modulation and emotional aspects (anxiety, depression, self-esteem) evidence the broad spectrum of action of exercise, resulting beneficial for the treatment of cardiovascular and metabolic diseases, as well as for the management of sexual dysfunction. However, the conventional forms of physical exercise offered in CPMR programs seem little attractive to provide the necessary adherence to treatment, justifying the search for new strategies3,15-19. In that context, ballroom dancing, a popular, ludic, pleasurable and socializing activity, should be considered, because it might contribute to increase adherence to exercise practice and optimize its benefits. The manifestation of sexuality can be potentiated by the combination of music and physical activity, in a situation that naturally propitiates high levels of well-being hormones, such as endorphins6,15. Since 2007, in our CPMR programs in the city of Florianopolis, Santa Catarina state, ballroom dancing has been a mean of physical conditioning, with the adoption of various rhythms (forro, bolero, samba, merengue, waltz, rock and roll, and salsa). Rather than teaching the technique, which would require frequent interruptions, we have been aiming at maintaining patients active as long as possible to sustain their target heart rate zone during exercise training. By doing so, we have achieved higher adherence, with a better chronotropic response and arterial blood pressure control, factors widely associated with sexual dysfunction and even cardiovascular outcomes20,21. The advantage of dancing as compared to conventional exercise methods incorporated to CPMR is mainly due to its characteristic of bringing people closer together, both physically and emotionally. In that context, ballroom dancing can be seen as a strategy to concomitantly treat cardiovascular diseases and sexual dysfunction.

Impact of isolated aerobic exercise in obese adolescents: systematic review

The juvenile obesity is currently one of the most serious public health problems. Changes in lifestyle, involving a combination of diet and physical activity, are essential elements in the management of obesity. However, it has been suggested that the prevention and treatment should emphasize the increase of physical activity rather than dietary treatments. To present the best available evidence from the controlled randomized studies to screen the impact of isolated aerobic exercise on cardiovascular and metabolic parameters in obese adolescents. Methods: Systematic review according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Were included randomized and controlled clinical trials of electronic databases: MEDLINE (via OvidSP), LILACS, and SciELO. Results: Four articles were identified, showing improvement in anthropometric measures, lipid and glycemic profiles. One of the articles demonstrated improvement in the systolic blood pressure (SBP) and diastolic (DBP), the maximum oxygen uptake. Conclusions: This systematic review has provided evidence on the impact of the interventions in isolated aerobic exercise in improving cardiovascular and metabolic parameters in obese adolescent population. Only four articles were identified, and further studies with greater scientific rigor are needed to confirm the scientific evidence.

Dance, Heart Failure and Erectile Function: Perspective of Better Clinical Management?

Na fisiopatologia da Insuficiência Cardíaca (IC) tem-se dado destaque à hiperatividade simpática e à inflamação sistêmica de baixa intensidade, aspectos também presentes na disfunção erétil (DE). O exercício físico constitui-se estratégia que proporciona melhora desses parâmetros sendo plausível a hipótese de que quando exercido por meio da dança proporcionaria melhores resultados. Ao unir atividade física e música, a dança seria capaz, dentre outros mecanismos favoráveis, aprimorar o funcionamento das redes neurais centrais e periféricas, contribuindo para o restabelecimento da normalidade da função neuro-hormonal e redução da resposta inflamatória, o que aumentaria a eficácia do tratamento tanto da IC quanto da DE.